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Background and aim; This thesis examines the mental health (MH) trajectory of Foundation Year junior doctors (F1s) in their first year of clinical training and the role of Occupational Health (OH). There is limited research in this field. A literature review identified that OH is often poorly utilised (Cohen et al, 2016), and no literature examined the role that OH might be able to offer for this year group has not been examined. There is a poor understanding of how best to emotionally support doctors in general, specifically F1s, to sustain their mental well-being, reduce their suicide risk and address any factors that might be associated with these phenomena (Brooks et al, 2011). Methodology: Thematic Analysis (TA) was the qualitative method used for this research and semi-structured questionnaires. A sample of ten F1s who had self-declared as experiencing or having had health conditions (both MH and with a physical health (PH) condition impacting on MH) were interviewed twice: once at the beginning (T1) and once at the end of their first year (T2). Interview questions explored experiences of the transition year, OH and of screening as an intervention. Personal reflexivity is an important part of the methodology, and is discussed alongside the findings of a literature review and the analysis of participant interviews. Analysis: The analysis identified themes across the T1 and T2 interviews. The following themes formed the basis of the T1 interviews: 1. Health seeking behaviour and OH 2. Internal world of doctors 3. External world of doctors -the transition and changes experienced by doctors. 4. Professional guidance, policy and politics. Key themes from the second (T2) interviews were screening and follow up interviews was found to be valuable .The interviews were found to offer an opportunity for individual reflexivity which the doctors found beneficial and supportive. Main Results: Those with long standing MH or PH conditions came to accept that it was "part of themselves" and something they needed to manage during this transitional period. One of the most notable findings was the importance of having an approachable and consistent individual who was the point of contact for the F1 who would follow them up if they did not attend or missed a session. F1's contact with OH, they still reported a tendency to feel that they were wasting someone's time if their mood was low. The findings of this study suggest that OH has a key role to engage with F1s early in the induction process with regards to screening and to recognise warning signs as well as to make contact at times of risk. The research shows that when screening and follow up is offered to F1s by OH for those with a previously known, or current, mental and physical ill health condition it is valued as a worthwhile intervention Discussion: This study additionally explored the findings relating to OH specifically through the lens of psychoanalysis. A hypothetical working model was developed, using the work of Steiner (1993) and Jaeggi (2014) in particular, to understand what is happening to F1s as they progressed through the year. This offers a novel contribution to existing literature. Limitations: This was a time limited study with a small, self-selected sample size. This study could be repeated across a larger population. Conclusion: This research makes a novel contribution to understanding the challenges in delivering good OH clinical support to F1s in a system where stigma concerning MH issues, still operates. This study indicates that OH has a key opportunity to support F1s early in their clinical year to promote and enhance their health and well-being during the transitional period to Foundation Year Two (F2). Screening as intervention offered this group of F1s the opportunity to build an ongoing relationship with OH to facilitate their continuing well-being in a multitude of ways. These include recognising the importance of the "secure base" OH provides, and allowing for ease of access to a key contact in OH and the opportunity to build a relationship with this contact who might recognise signs of declining well-being and "reach out" if an F1 fails to attend appointments. Other important findings for OH were that these F1s gained insight and acceptance of MH conditions and increasingly drew on the potential of OH to provide a 'reflexive space' to support them as they transitioned to F2 and to facilitate work adjustments if necessary. These findings can be used by OH, to support the health and well-being of F1 who have a high prevalence of MH with associated risk factors (Brooks et al, 2011) Recommendations for future research: further use of clinical diagnostic tools (e.g PHQ9 & GAD7) to monitor HWB of F1 during the screening FU process. Keywords: Occupational Health, mental and physical health, support, transition, Foundation Year 1 doctors, junior doctors.

The primary aim of the work included in this thesis was to investigate the effects of breaking up sitting time on cardiometabolic risk markers and appetite. The three acute experimental chapters in this thesis sought to do this by examining postprandial concentrations of glucose, insulin, triglycerides, high-density lipoprotein, acylated ghrelin and total peptide YY. Additionally, subjective appetite, physical activity energy expenditure and energy intake were investigated. In study one, postprandial glycaemia was attenuated in young, healthy adult men when breaking up sitting every 20 min with 2 min moderate-intensity physical activity (PA) following a high glycaemic index breakfast, compared with an uninterrupted sitting condition. There was no attenuation in glucose observed if a low glycaemic index breakfast had been consumed, suggesting that in a metabolically healthy sample, breaking up sitting may only be beneficial when high glycaemic index meals are consumed. In study two, postprandial lipaemia was improved across an 8 h period when breaking up sitting every hour with a short, high-intensity PA bout compared with uninterrupted sitting. This strengthens the efficacy of short bouts of PA of a high-intensity as strategy to improve postprandial lipaemia. However, data from study one and three suggests that attenuating postprandial glucose or insulin may require more frequent breaks in sitting than hourly PA bouts. Studies two and three observed no changes in appetite regulating hormones. Despite this, there was a suppression in subjective appetite when participants engaged in hourly high-intensity PA bouts, suggesting that a minimum threshold of PA intensity is required to elicit these effects. However, despite moderate-intensity PA breaks in sitting not suppressing appetite, no compensatory responses were observed in appetite or energy intake, resulting in an acute relative energy deficit. These findings suggest that this type of activity regime could assist in weight management programmes. Study four sought to investigate the efficacy of a workplace cluster randomised controlled trial at reducing workplace sitting. The multicomponent intervention did not reduce workplace sitting time. However, time spent in prolonged sitting bouts (> 30 min) was reduced and stepping time increased. This was concomitant with reductions in waist circumference and an increase in fat-free mass, demonstrating that a low-cost, short-duration, multicomponent intervention can be effective in changing sedentary behaviour patterns in the workplace. Overall, this thesis adds to the current evidence examining the effects of breaking up sitting on postprandial cardiometabolic risk markers and appetite, in addition to demonstrating the efficacy of a short-term low-cost multicomponent intervention at reducing prolonged sitting in the workplace by using strategies similar to those examined in studies one and three. Chapter eight summarises the significance of the findings from all four experimental studies whilst synonymously highlighting future directions for research in this area of the field.

This research has explored how seventeen middle managers in the social housing sector manage employee stress and the reasons they take the approach they do. The research has been conducted in response to the increased prevalence of workplace stress. While workplace stress and mental well-being continues to rise up the political and business agenda; the most recent statistics from national and international organisations identify that the management of stress in the workplace needs to be improved. Workplace stress is a global issue for which the related direct and indirect costs are only beginning to be quantified, although the estimated cost of work-related depression in Europe is €617 billion per year. Furthermore, there is a trend towards devolving responsibility for managing workplace stress to individual managers. Despite their increasing responsibilities for managing stress at work, middle managers often lack the authority, skills and capacity to make the changes required to prevent workplace stress. Evidence suggests that middle managers are in a complex and challenging position between their superiors and more junior staff which can exposes them to role related stressors. The United Kingdom (UK) social housing sector is a particularly complex and vital one, comprising of a variety of private, public and charitable enterprises that build, manage and maintain housing stock. The complexities, political and financial challenges facing the sector expose middle managers and their staff to an increased risk of work-related stress. This study adopted a constructivist philosophy, relativist ontology and subjectivist epistemological position. Semi structured interviews were conducted with seventeen middle managers working in the social housing sector in an attempt to explore and better understand how they approach managing work-related stress experienced by the employees. The findings of this study are that, in contrast to what the extant literature recommends, participants adopt predominantly reactive approaches to managing employee stress and deploy mostly secondary and tertiary stress management interventions. The study also found that the participants tend to focus on managing stress caused by workload, relationships at work and home-work interface. Furthermore, this study contributes new insights into how middle managers are managing stress in practice such as, using their personal experiences of managing their own stress and by observing the behaviours and practices of other managers. This study also highlights a number of contemporary stressors in the context of the social housing sector. These contributions provide new practical insights into how middle managers might more effectively manage stress in the workplace. The need and focus of this research arose from the researcher's practice as an occupational health and safety consultant working with social housing providers across the UK. His work involves advising housing providers and their middle managers on matters of employee stress and health. Often this advice is sought when the employee is already unwell and needs help to recover. This reactive approach to workplace stress is contrary to what UK health and safety (H&S) law requires and is known to be ineffective in tackling stress at work. The researcher's professional experience in the housing sector and the trend in devolving responsibility for managing stress at work to middle managers, provided the initial spark for this research.

Introduction The incidence of musculoskeletal disorders remain the most common single condition, by incidence, affecting the working population. This remains true even though the apparent historic causation of manual handling, has reduced significantly. Back pain alone has been termed a 20thcentury medical disaster, which has reverberated into the 21stcentury, with 85% of low back pain having no clear clinical diagnosis yet individuals continue to seek a clinical solution. Understanding pain remains as complex as ever with very little evidence to suggest progress. The overall scale and cost of MSDs in the workplace are not easily identifiable as objective and accurate data are rare. Other workplace incidence and costs are either, not recorded or not published, in documents or grey literature, that are generally only accessible to individual organisations on a regular basis. Objectives The epistemology of this thesis is complexity and the extent to which this influences outcomes. The trilogy of complexity considered includes: 1. The issues facing organisations in how they prevent and manage MSDs; 2. The individual's perspective and what they understand about possible causation, their beliefs, fears and expectations; 3. The interface with clinical and non-clinical practitioners, and whether interventions provided, are beneficial to the individual. Consideration of the multiple perspectives that arise from the various influences affecting the organisation, the employees within that organisation and the practitioners, has been possible by the metaphoric use of a "bricolage" methodology, and suggests that the current medical model is no longer appropriate. Methods A mixed method research design comprising four studies was undertaken. Firstly, a retrospective quantitative study of data (n = 21,092) from benefits provided by four organisations followed by a qualitative case example study (n = 21) of supporting documents and clinical information. These studies then informed the need for a qualitative study (n= 9) symptomatic individuals who participated in a focus group and (n= 6) face-to-face interviews and finally a qualitative study of practitioners involved in the provision of treatment services to the participating organisations. The data from each study informed the others and the data merged with the findings from the literature review and common interventions. Conclusions A disparity was found between what has been identified in literature and what actually is considered in clinical practice. The healthcare industry operates in "silos" and this separation of disciplines is reflected in organisational management. The range of underlying risk factors, evident in modern society, which are affecting or may affect an individual's future musculoskeletal health are not being addressed by the medical model, and practitioners require training, or need to work in a multidisciplinary team, if they are to improve long-term outcomes. This thesis discusses the complexity of the multifactorial nature of musculoskeletal health, and provides a framework to challenge current practice and promote a fundamental change in the way in we assess, and treat the range of MSDs including a move towards educating individuals to take personal responsibility.

Occupational ill-health statistics have consistently placed construction as a high risk industry. Younger workers (aged 15-24) constituting 24% of the UK construction workforce are a high risk group for occupational illnesses from more exposure to physical work factors including noise, vibrations and the handling of dangerous substances. The provision of effective training to young people entering the workforce is crucial in preventing occupational illnesses and improving the industry s occupational health (OH) performance. However, whilst the delivery of training in industries such as healthcare and aviation has rapidly been shifting from pedagogical/instructional theoretical frameworks towards more learner-focused andragogical approaches rich in hands-on/experiential learning, training in the construction industry has not taken full advantage of new training approaches. This thesis aims to examine OH training methods for UK construction apprentices and evaluate the role and effectiveness of a simulation-based training strategy, in order to enhance the OH training for construction apprentices. It presents and adopts innovative wearable, hands on simulations that were designed and developed at Loughborough University, called LUSKInS (Loughborough University Sensory and Kinaesthetic Interactive Simulations), to assess their value and utility in the training of construction apprentices. In order to address the research aim and provide comprehensive answers to the research questions, the research adopted an inductive, multimethods approach, in which the collection and analysis of data combined quantitative and qualitative research methods. First, reviews of theories of learning and existing research utilising simulation learning tools in various educational settings were carried out, to gather insights into how people learn, the theoretical underpinning to the use of simulations as well as the efficacy of simulation-based training. This analysis indicated that use of simulations that is based on the review and application of relevant learning theories has significant potential in enhancing the learning of construction apprentices. Furthermore, the analysis identified a need to move from traditional direct instructional training methods towards more experiential and learner-centred methods in construction education and training. Accordingly, the subsequent use of wearable simulations in the study was guided by experiential and constructivist learning principles, meaning that the research participants were provided with interactive and engaging contextual experiences, which allowed them to actively construct their own understanding, as opposed to them passively acquiring OH information from external sources. Second, fieldwork data was gathered through survey questionnaires, participant observations, semi-structured interviews and photo-elicitation. This involved construction apprentices and instructors from three colleges located in London, Midlands and Norfolk. Together, the quantitative and qualitative data confirmed that a traditional instructor-centred approach, which places emphasis on the passive transmission of information and the use of standardised presentations, texts and workbooks dominates the delivery of OH training for construction apprentices, despite many of the trainees in the study expressing a preference for highly engaging, active or hands-on methods of learning to passive, information-based approaches. It was clear from the findings that by failing to take into consideration the diversity in learning preferences among the trainees and the crucial role of interaction and learner participation in the learning process, the existing instructional strategies do not effectively support the learning of construction apprentices. Notably, the findings revealed that the prevailing views of training amongst instructors and their leaders, which endorse direct instructional strategies and uniformity, create barriers for opportunities to create and utilise more progressive learner-centred training strategies for construction apprentices. The findings related to the impact of the wearable simulations indicated that the use of hands-on simulations can be beneficial to the learning of construction apprentices. The simulations were found to be effective in developing the apprentices understanding of OH illnesses, as well as in changing some of their attitudes, particularly towards prioritising their health at work and adopting correct work practices, for example, wearing appropriate protective clothing when carrying out their work. In addition, the findings also showed that the simulations were largely perceived to be enjoyable, engaging and easier to understand compared to traditional training methods. However, challenges associated with the use of simulations were also identified, including the relatively high costs in terms of both time and money required in their development and implementation as well as challenges associated with trainer competence and adapting curricula to the newer training approach. Based on the empirical evidence and the related theoretical explanations, the study develops a set of propositions which not only challenge the current training paradigm, but more importantly identify the factors that can optimise the OH training of construction apprentices and overcome some of the barriers that were identified. In addition, a conceptual framework and typology of trainees learning styles are developed, in order to provide some practical guidance on how appropriate training strategies can be selected, as well as assist the wider application and integration of simulation learning tools.

The study aimed to examine the contributions of two corporate, non-health, transnational, Sustainable Healthy Workplaces (SHWs) to the achievement of the Millennium Development Goals (MDGS) in Nigeria. The research questions in this study sought to determine the contributions made by SHWs to combating malaria and 'other diseases' and ensuring gender equality in health at work, thus ascertaining the contributions of the studied organisations to the MDGs 3 and 6 in Nigeria. A qualitative, eclectic case study of two SHWs was carried out. Data were sourced through documentary analysis and the use of semi-structured interviews, with 22 and 13 purposive sampled participants at organisations 'A' and 'B' respectively. Also, descriptive and thematic data analyses were utilised for numerical and textual data respectively, and these analyses were then compared and interpreted. The results showed that both organisations contributed to the achievement of the two MDGs studied with policies and practices that were available but inadequate. Both implemented relevant and gender-specific policies but conducted inadequate workplace health promotion programmes (WHPPs). Organisation 'B' had basic structural facilities to promote healthy lifestyle choices, which were missing at organisation 'A'. Given this, there was no record of significant levels of non-communicable diseases (NCDs) at organisation 'B', unlike organisation 'A' with its remarkable record. A decline in reported cases of malaria (a communicable disease - CD) occurred throughout the study period at organisation 'A', with the highest recorded in 2012 (25.4%) and the lowest in 2014 (21.8%). No pattern was observed at organisation 'B' but the highest incidence of this disease was recorded in 2014 (75.6%) and the lowest in 2013 (30.7%). At organisation 'A', there was a steady rise in sickness absences among male employees, contrary to the documented decline among that of female employees. No consistent pattern was observed regarding sickness absence for gender categories at organisation 'B'. Deaths were recorded at organisation 'A' during the study period, except in 2014 when there were none. Organisation 'B' had no recorded mortality throughout the entire study period. The findings from the literature review, using the Critical Appraisal Skills Programme (CASP) and Clearinghouse for Labour Evaluation and Research (CLEAR) checklists for quality assessment of the selected articles, showed that any effort aimed at preventing and combating diseases while ensuring gender equality in health among the workforce had a positive impact on stakeholders. This led to the most important element of the social and economic development agenda, including the MDGs, being addressed. Additionally, findings from organisations 'A' and 'B' revealed positive, but inadequate, and varied contributions to the attainment of the MDGs, with better performance recorded at organisation 'B'. This implied the need for these organisations to have done more in order to make a better contribution to the MDGs. The MDGs had 2015 as their target date, but they have now been replaced by the Sustainable Development Goals (SDGs). Hence, the lesson learnt from MDGs can be transferred to the implementation of the current SDGs, which are termed the 'Global Goals'.

This thesis is concerned with the occupational health of white-water raft guides working in the UK and details how working conditions and practices can lead to an increased risk of unintentional injury or ill-health. Work-related injury and ill-health is a problem across all industries in the UK, with some employees, such as those working in the Outdoor Industry, being more at risk than those working in other industries. Biological and psychosocial factors have been associated with work-related health in a range of occupational settings; however, the majority of previous studies have used non-physical occupational samples, such as office workers. Very little is known about the occupational health risk factors of those working in the Outdoor Industry, such as white-water raft guides, especially as health and safety strategies currently in place are client focused as opposed to provider focused.

Chronic Embitterment is a persistent and disabling negative reaction to an event perceived as unjust and is a frequent presentation in NHS Occupational Health settings. It is associated with distress and impairment and is difficult to treat. A lack of research on the psychological processes which underpin Chronic Embitterment has led to a lack of clarity about why some people become embittered while others, facing the same circumstances, do not. Certain psychological variables were proposed as potentially relevant. While rumination has been named as a characteristic feature of Chronic Embitterment, no published study had explored this association. In other studies, Positive beliefs about rumination have been indicated to underpin rumination. It was hypothesised that this may also be the case in Chronic Embitterment. Sense of Coherence describes a cognitive approach to problems which has been repeatedly linked to resilience following negative life events. The relationship of Sense of Coherence to rumination and Chronic Embitterment was unexplored. As both low Sense of Coherence and excessive rumination have evidence based treatments, exploring the roles of these factors in Chronic Embitterment was suggested as a useful direction for research. Seventy nine NHS staff attending two Occupational Health departments in greater London completed a cross sectional survey in relation to the psychological correlates of embitterment. Correlations with the severity of embitterment were found in Affective Rumination and Sense of Coherence, but not Positive beliefs about rumination. Moreover it was found that the relationship been embitterment and Affective Rumination was mediated by Sense of Coherence. The implications of this finding for the understanding, prevention and treatment of Chronic Embitterment are discussed.

Petrol station attendants' exposure to gasoline vapours while refuelling vehicles has raised health concerns, especially in tropical countries like Saudi Arabia. This is due to the increase of gasoline vaporisation by the high temperatures and related weather conditions. This represents an increase risk of inhaling more vapours than its counterpart temperate countries. Furthermore, exposure during extended working hours (12 hrs shifts), with no vapour recovery system and the handling of gasoline containing a high percentage of volumes of toxic substances (e.g. BTEXs) have not been adequately addressed previously in Saudi Arabia. Therefore, this study was designed and carried out to investigate the validity of this concern by assessing and quantifying full shift exposures to gasoline vapours during the petrol filling process. Different exposure assessment methodologies were employed and evaluated for their suitability. The study assessed the exposures of 41 attendants via passive, active, and direct reading methods at twelve petrol stations with both high and low sales in the Eastern Province of Saudi Arabia. The study was conducted during the winter and summer months to test the seasonal variation of the pattern of exposure. The effects of the quantity of gasoline sold, the locations of the stations, weather variations (e.g. wind speed, temperature, and humidity) were tested. A purpose built mini-weather stations and modified thermometres were utilized to accurately monitor the prevailing weather conditions. Forward-looking infrared (FLIR) thermal image cameras were utilised to visualise the size and movement behaviour of the vapour plumes during petrol refuelling. Furthermore, analytical lab trials were carried out to characterise the gasoline vapour component under different temperatures. These were used to propose a new OEL. The geometric means of the personal passive results for BTEX and MTBE (0.18 ppm, 0.24 ppm, 0.09 ppm, 0.18 ppm, 1.57 ppm, respectively) were found to be relatively higher than those reported previously for Europe and North America. These results are discussed in the context of the impact that such exposure will have on people involved in this industry in petrol stations in Saudi Arabia.

The oil and gas industry is a vital contributor to the global economy and a key source of employment within oil-producing countries. Oil production is largely dependent on a skilled population who are adept in coping with the demands of an offshore environment. Due to the high risk nature of work offshore, it is a requisite that personnel engage in health promoting behaviours. The research aimed to identify aspects of offshore workers self care which required behaviour change and the behavioural determinants which were associated with engagement in self care. A mixed methods design was utilised to generate novel data and original findings. Phase 1 used a quantitative cross-sectional online survey to assess offshore workers’ (n=352, 53.6% response rate) health, quality of life, mental wellbeing and self care status. The findings highlighted key areas of concern, as indicated by negative scoring across measures, relating to: overweight/obesity; medication adherence; absenteeism (with regard to travelling offshore); medical evacuation; lack of adherence to 5-a-day fruit and vegetable guidelines; physical activity; smoking; hazardous alcohol use, and insomnia. Phase 2 used qualitative theory-based telephone interviews to explore self care behaviours from the perspective of offshore workers (n=16). Offshore workers who had completed a survey and indicated they would like to receive further information on the interviews were invited to participate. Both the interview schedule and data analysis were informed by the Theoretical Domains Framework (TDF). Healthy eating and physical activity were the behaviours most frequently discussed by offshore workers and identified as areas requiring behaviour change. TDF domains representing both behaviours included: beliefs about capabilities; beliefs about consequences; intentions; goals; memory, attention and decision processes; environmental context and resources; social influences; emotion, and behavioural regulation. Phase 3 used qualitative theory-based telephone interviews to explore offshore workers’ (n=13) self care behaviours from the perspective of remote healthcare practitioners. Both the interview schedule and data analysis were informed by TDF. Healthy eating and harmful/hazardous alcohol use were the behaviours most frequently discussed by remote healthcare practitioners and identified as areas requiring behaviour change. TDF domains representing both behaviours included: knowledge; environmental context and resources; social influences; emotion, and behavioural regulation. The findings, when triangulated suggest that offshore workers may benefit from the implementation of a self care intervention which targets healthy eating, physical activity and alcohol consumption. It is advised that the intervention target multiple self care behaviours and that development is underpinned by behaviour change theory to ensure effectiveness. The intervention may be tailored in accordance with the TDF domains identified in this research as determinants of healthy eating, physical activity and alcohol use behaviours.

This study was carried out using a Foucauldian discourse analysis and involved the examination of three statutory reports into the provision of occupational health in the workplace. The reports analysed were the Report of the Select Committee on the Bill for the Regulation of Factories (1832); the Safety and Health at Work Report (1972); and Working for a Healthier Tomorrow (2008). Additionally, analysis was carried out on oral events with nursing students, which sought to understand their perceptions of referral to occupational health. The objective of this study is to explore how referral is constructed through discourse, categorising how this practice is constrained or liberated by specific discourses and how nursing students are positioned by these discourses. My study highlights both structural and subjective barriers to the use of occupational health. At the structural level, it is observed that referral to occupational health commenced as a form of governmentality, introducing dividing practices which subjected the workforce to forms of classification and surveillance. For those classified as healthy a culture developed within workplaces in which health behaviours needed to comply with the standards set down by occupational health and by the risk management approach. Risk management processes and stigmatisation are used to ensure compliance with the state’s wishes for a healthy and productive workforce. This trend is seen across the reports analysed, and is increased within the Black Report to the surveillance of health both in and out of the workplace for those of a working age. Subjectively, occupational health was identified as a disciplining and subjugating structure by the nursing students. The students evidenced notions of Cartesian duality in their discussions of the outcomes of referral, as they readily accepted surveillance of the body whilst seeking to avoid surveillance of their mental health capabilities. Through observation of architectural signs and organisational images of discourse, students categorised occupational health as an instrument of the higher education institute and not as a form of holistic health support. The research highlights how occupational health acts as a barrier to the students’ fulfilling their societal roles as good students and good nurses. The research also highlights a desire on the part of the student nurses to utilise occupational health within a public health framework which addresses their health in a preventative rather than punitive manner.

The increase in certified sickness absence recorded in most European countries during the last decade is of increasing concern to public health agencies. While sickness absence can promote rest and recovery from illness, it may also have negative consequences, including increased risks of inactivity and isolation, poorer quality of life and increased uptake of health services. In the Republic of Ireland (ROI) sickness certification is part of General Practitioners’ (GPs’) contractual service to the Department of Social Protection (DSP). Sickness certificates are also issued to patients as evidence of illness for employment purposes. There is limited research exploring GPs certifying practices in the Republic of Ireland. The aim of the thesis was to explore perspectives on sickness certification in general practice in Ireland. The data collection consisted of three stages. Study 1 consisted of in depth individual interviews with 14 GPs across 11 primary care practices in Ireland. Study 2 was based on an on-line questionnaire survey using a number of vignettes with 62 GPs working in primary healthcare. Finally, study 3 consisted of a focus group conducted with eight GPs in a large urban practice in Ireland. Qualitative analysis was conducted in vivo using content and simple thematic analysis techniques. Quantitative data was analysed by descriptive and inferential statistics using PASW version 18 statistical software. Combined results indicate that GPs can find their role as certifiers’ problematic and a source of conflict during the consultation process with patients. GPs concerns are with breaching patient confidentiality and in particular disclosing illness to employers. They reported feeling inadequate in dealing with some cases requesting sickness leave, including certification for adverse social circumstances and they felt a need for better communication between themselves, employers and relevant government departments. Willingness to issue a sickness cert may be influenced by the nature of the patient’s presenting problem. A psychological problem generated greater belief that patients were unfit for work, and GPs were more sympathetic and showed greater satisfaction with the decision they had made to certify these patient in comparison to patients with a physical problem. Average sickness certification periods were longer in cases of psychological nature (1-2 weeks) in comparison to the physical complaint (4-7days). Overall GPs displayed a negative feeling towards prescribing sickness leave and there was a perception that sickness certificates were being used by employers as a management tool in controlling absenteeism. GPs also mentioned cultural factors in work place absenteeism and lack of rehabilitative pathway as impacting on sickness certification practices in Ireland. Issuing a sickness certificate appears influenced by medical and non-medical factors. Potential exists for improving the system, but requires significant engagement with other stakeholders such as employers and social benefit agencies. Focus should be placed on referral and rehabilitative pathways for patients to ensure appropriate certification and early return to work.

Healthcare regulatory bodies require incident reporting and investigation as a way to identify operational hazards and shortcomings in safety. The goal of such reporting is to reduce factors that create unsafe conditions (OSHA, 2015). This often equates to finding problems and fixing them. Learning from errors is known to some researchers as Safety-I or improvement from learning from mistakes. Some research now suggests that there is more to be gained by learning from most healthcare episodes: the things that go right. The relationship between the old and new view of safety is sometimes proposed as one of substitution and sometimes as one of supplementation, but what is agreed upon is the underlying assumption that the complexity of current healthcare systems requires safety scientists to start thinking radically differently about how to create and sustain a safe and resilient healthcare system for patients (Pendersen, 2016). By emphasizing the importance of understanding the uncertainties and trade-offs in everyday work with its successes and failures, Safety-II offers a unique perspective on harm reduction in healthcare. Therefore, this qualitative study uses text data to examine and explore how condition reports advance Safety-II in occupational healthcare settings.

The consequences of stress in critical care nurses include physical and mental health consequences: altered coping, burnout, and turnover intention. The relationships between stress, coping, burnout, and turnover intention have been assessed outside of the United States; however, there remains a knowledge gap surrounding these relationships in critical care nurses in the U.S. The purpose of this dissertation was to examine these relationships guided by the Transactional Theory of Stress and Coping. A cross-sectional, correlational design included 82 critical care nurses working at a level one trauma center in Midwest, United States. Participants completed an online Qualtrics survey with the following instruments: Expanded Nursing Stress Scale, Coping Inventory for Stressful Situations – Short Form, Maslach Burnout Inventory – Human Services Survey for Medical Personnel, and Turnover Intention Scale. There was a 55.4% response rate of those who met the inclusion criteria: registered nurse working full time in critical care for 6 months or greater. In this sample, 84.1% of participants reported moderate to high levels of stress, 96% reported moderate to high levels of burnout, and 65% indicated they were likely to leave their position. Multiple regression was utilized to assess the relationships between the variables and results revealed stress had the greatest impact on turnover intention (Beta = 0.378; p = 0.008), and emotion-focused coping had the greatest impact on burnout (Beta = 0.277; p = 0.04). Analyses using regression with mediation were utilized to determine if coping style mediated the transition of stress to burnout, and the researcher found emotion-focused coping fully mediated the transition from stress to burnout (p = 0.005).The results of this study indicate critical care nurses continue to have high rates of stress, burnout, and turnover intention. Future research can build on these findings to determine what intervention(s) may be effective to improve emotion-focused coping techniques, which can help critical care nurses be less reactive during emotionally charged situations leading to decreased stress, burnout, and turnover intention. Emotional intelligence (EI) training may be an effective intervention to combat emotion-focused coping. Individuals with higher levels of emotional intelligence may be better protected from developing burnout, due to more effective coping techniques which helps to better manage stress; Other interventions may include counseling, yoga, and mindfulness; however, future research is needed to determine the most effective intervention.

Background: Due to the nature of their work, psychiatric nurses at Northwest Ohio Psychiatric Hospital (NOPH) encounter traumatic and emotionally exhausting situations almost every day. This exposure increases work-related stress, trauma, and vulnerability to compassion fatigue (CF) and burnout. CF and burnout can result in emotional and physical fatigue that affects one's ability to care for others. One can increase resilience and compassion satisfaction (CS) by identifying CF's early indications and symptoms and mastering efficient self-care techniques.Aim: This Doctor of Nursing Practice (DNP) project aims to bring awareness to psychiatric nurses at NOPH about CF and burnout and educate them on ways to improve resiliency and compassion satisfaction as professional nurses.PICOT: How do psychiatric nurses at NOPH (P) who are at increased risk for CF benefit from a webinar-based educational intervention (I) to identify and reduce symptoms of CF and improve compassion satisfaction (O) one month after intervention (T) compared to pre-intervention (C)? Design: Psychiatric nurses completed Professional Quality of Life surveys (ProQOL 5) (Stamm, 2010) before and one month after an educational intervention designed to teach about CF and self-care strategies. Comparisons of ProQOL scores, which measure compassion satisfaction and CF (burnout and secondary trauma scores), determined if an educational intervention effectively improved CS and reduced CF (significance level at p

While the importance of assessing the occupational consequences of insomnia and other sleep disorders is emphasised in clinical nosologies and research guidelines, there is little consensus on which aspects of occupational performance should be assessed, how such impairment should be measured, and how outcomes should be reported. The research programme described in this thesis aimed to address this issue. Chapter 1 presents a systematic review and methodical critique of studies reporting those aspects of occupational performance most impacted by (or most frequently associated with) insomnia symptoms and degraded sleep quality. Equivocal results, wide variations in reporting conventions, and the overall lack of comparability among studies, strongly indicated the need to develop a standardised metric able to quantify sleep related occupational performance and serve as an assessment and outcome instrument suitable for use in research and clinical settings. Informed by the literature review, Chapters 2-4 describe the development and validation of the Loughborough Occupational Impact of Sleep Scale ( LOISS ), a unidimensional 19 item questionnaire that captures sleep-related occupational impairment across a number of workplace domains over a 4-week reference period. Chapters 5-7 describe LOISS outcomes from: i) surveys in a random population sample; ii) a representative sample of the UK workforce; and iii) a clinical sample of patients with obstructive sleep apnoea (before and after treatment with CPAP). Overall, the scale showed strong internal consistency (Cronbach s alpha range=0.84-0.94) and test-retest reliability (r=0.77, r2=0.59, p<0.001), high levels of criterion validity (significantly discriminating between good and poor sleepers), and proved an effective outcome measure in OSA. From the survey data reported in Chapters 2-7, LOISS score distributions showed no consistent gender difference but did show a significant ageing gradient, with sleep-related occupational impairment declining with increasing age. In conclusion, the work presented here supports the usability, validity and reliability of the LOISS as an assessment and outcome instrument, and also demonstrates the utility of this instrument in exploring the dynamics of sleep-related occupational performance

Exposure to dust and latex allergens has been well established as a cause of health problems but there have been few studies that have examined the extent of problems in latex glove manufactures, especially in Thailand. Therefore, the overall aim of the study was to determine whether exposure to dust and latex allergens was associated with health problems in Thai latex glove manufacturing workers.The study was conducted in 3 latex glove factories in southern Thailand that employed 1,481 workers (931 Thai and 550 foreign workers). Full shift personal air sampling of workers in 10 different departments was carried out using the IOM Multidust™ sampling Head equipped with 25 mm 1.0 mm Polytetrafluoroethyene filters at a flow rate of 2 L/min. A commercial ELISA kit was employed to quantify levels of the Hev b 6.02 latex allergen in air sample extracts. Information on demographics and, occupational history, exposures and health related problems attributed to work was collected by questionnaires completed by Thai workers. Lung function testing using a spirometer was also conducted among Thai workers. Univariate linear mixed-model analysis was used to determine differences in the dust and specific latex allergen concentrations between factories, departments, shifts and days. Multivariate linear mixed model analysis was used to determine exposure determinants to estimate exposure concentrations of inhalable dust and specific latex allergen. Logistic regression analysis was used to determine association between exposure to inhalable dust and specific latex allergens.292 air samples were collected. The geometric mean (GM) and a range of inhalable dust was 0.88 (0.01 – 12.34) mg/m3. The highest dust levels were found in the Stripping 3.01, (0.73 – 12.34) mg/m3 and lowest in the Office 0.11, (0.06 – 0.92 mg/m3) departments. Hev b 6.02 levels were 9.35 (4.08 – 345.53) ng/m3 and the highest and lowest levels were also found in the Stripping [19.76, (4.72 – 192.90) ng/m3] and Office [5.60, (4.37 – 14.64) ng/m3] departments. Factory and Department were important determinants of both inhalable dust and Hev b 6.02levels. 660 (157 men, 503 women) out of 931 workers completed a self-reported questionnaire. The prevalence of health problems attributed to work was highest for skin problems (25.0%) followed by Rhinitis (23.9%), conjunctivitis (22.5%) and cough (16.2%). Cumulative exposure to dust was associated with conjunctivitis attributed to work (OR and 95%CI = 1.02, [1.00 - 1.03]) after adjusted for confounders. A negative association was found between rhinitis and exposure to average dust level (OR and 95%CI =0.69 [0.48 - 0.99]). No other associations were found between either exposure to dust and self-reported ill-health. There were also no association between exposure to Hev b 6.02 and ill-health although skin problems were associated with the highest Hev b 6.02 level (OR and 95% CI = 1.72 [1.02 - 2.91]). Lung function testing was conducted in 474 Thai workers; 41 had airway restriction, 3 airway obstruction and 1 with a combined problem. Cumulative exposure to dust was associated with airway restriction after adjustment for confounders (OR and 95% CI = 1.02 (1.00 - 1.04).

Occupational skin diseases is one of the most commonest occupational disease groups accounting for about a fifth of all occupational diseases in the UK. Current guidance from the HSE for skin health surveillance is the skin inspection by a responsible person in the workplace. The use of teledermatology can be attractive to reliably conduct skin surveillance in the workplace, and a tool box to take reproducible standardised photographs from the hands of workers in the workplace was developed. Aim of this thesis was to assess diagnostic accuracy and validity of this toolkit with visual inspection as criterion standard for the presence of minor or major hand dermatitis and by scoring the hands and photographs with the validated Hand Eczema Severity Index. Workers from four different occupations were recruited over a 7 month period and 332 workers were assessed on a repeatedly basis producing 1212 assessments. Skin hydration and transepidermal water loss was measured and a symptoms questionnaire was completed by every participant. A high prevalence of skin problems was found in our study: 70% of the participants presented at least once over the study period with minor or major skin symptoms. A high intrarater reliability compared to the visual assessment was shown for the teledermatologic assessment with an agreement of 88%, kappa of 0.79, and a positive likelihood ratio of 7.4 and negative likelihood ratio of 0.07; about 5% of participants with normal skin were over-diagnosed compared to the visual inspection. The interrater reliability was low. The biophysical parameter did not distinguish between normal and affected skin. The tool kit has shown to produce reliable and standardised high quality photographs, the assessment of the photographs showed a very good intrarater agreement to the criterion standard. The toolkit would allow regular skin surveillance with minimal interruption in the workplace and with reliable results from the assessment.

This thesis set out to explore the neglected field of nurses’ occupational health. Evidence from the three case study hospitals confirms that attitudes toward nurses’ health changed between 1888 and 1948. The health of nurses was an issue that was always taken seriously but each institution approached the problem differently and responses showed much variation over time. There were good reasons for this but the failure to adopt a coherent and consistent policy worked to the detriment of nurse health. This difficulty helps explain the ambiguous treatment of occupational health within wider histories of nursing. This can lead to the erroneous conclusion that occupational health was somehow neglected by contemporary actors, thereby facilitating the omission of the subject from historical studies concentrating on professional projects and the wider politics of nursing. This study takes a different approach showing that occupational health issues were inexorably connected to these nursing debates. Occupational health cannot be understood without reference to professional projects. This is as true in debates where occupational health was obscured as it was in cases of overt concern. The history of the occupational health of nurses is also important because it offers a new perspective on two other themes central to nursing history, particularly class and gender. This focus helps understand why attitudes towards the care of sick nurses changed over time and varied between different types of institutions. By concentrating on individual nurses’ experiences we reveal something new about the way national conversations affected ordinary nurses’ lives. Recognition that nursing presents a serious occupational health risk is a relatively recent phenomenon; it was not until the 1990s that most nurses had access to occupational health units. This study not only sheds light on why nurses’ health attracted little attention before the Second World War but also explains why this situation began to change from the 1940s.

A deficient safety culture has been implicated in a number of organisational accidents from a range of high hazard industries. Despite its implications for safety, many questions about safety culture remain unanswered. In order to contribute to the literature on this topic, this thesis set out to investigate the role of trust in safety culture. The oil and gas industry was chosen as the context for study due to the hazardous nature of its work, the industry’s focus on continuous improvement in safety performance and the interest shown by oil companies in participating in safety research. Leading models of safety culture have stressed the importance of trust in developing and maintaining patterns of safe behaviours at work. This thesis proposed a new model of safety culture based on dual attitudes about trust. This model states that explicit attitudes about trust are part of safety climate and that implicit attitudes about trust comprise some of the basic underlying assumptions that are the deepest level of safety culture. In order to test this model, this thesis developed a method to measure implicit attitudes about trust in an industrial setting. Using this method, two studies of dual attitudes about trust were conducted at different UK gas plants. In both of these studies, different patterns of results were found for measures of explicit and implicit attitudes about trust for workmates, supervisors and the plant leadership, respectively. These findings support the proposed model suggest that explicit and implicit attitudes about trust are separate constructs that may influence different types of safety behaviours.  Positive relationships were found between measures of explicit attitudes about trust and self-report items about safety behaviours like reporting incidents and challenging unsafe acts.  These findings were taken as a step toward validating the proposed model.

Tactical athletes (i.e., military, law enforcement, fire service, and emergency medical response personnel) protect and serve local and national communities. The work environments of tactical athletes have high performance demands that influence injury rates and affect overall wellbeing. Measuring the movement requirements of tactical athletes can help build the understanding of what physical attributes are needed to perform with lower risk of injury, enhanced career longevity, and improved quality of life. Motion capture technologies record biomechanical patterns that describe movement quality, measure recovery after injury, and can be used to improve performance. While motion capture has traditionally been limited to laboratory environments, advances in markerless motion capture and inertial measurement unit (IMU) technologies allow movement biomechanics to be more easily measured outside of laboratories. Tactical athletes’ dynamic operational environments are responsible for many of the increased risks they experience, so measuring movement in those environments also maximizes the applicability of the information gained. Therefore, the purpose of this research was to determine the current uses and the accuracy of motion capture technologies in tactical athletes and to apply IMUs in an evaluation of law enforcement movement patterns.Aim 1 systematically reviewed the current uses of accelerometers and IMUs to measure movement in tactical athletes. The results of this aim identified that accelerometers and IMUs were much more frequently used to measure movements of military personnel than first responders (i.e., law enforcement officers, firefighters, emergency medical service personnel). Additionally, accelerometers’ most common outcome measure was physical activity. There was a notable need to use IMUs to measure occupational exposures specifically in law enforcement and emergency medical service personnel.Aim 2 evaluated the validity of markerless, IMU, and red, green, blue, and depth camera motion capture systems against markered motion capture recording dynamic movements. The results of this aim indicate that of the three evaluated motion capture systems, markerless motion capture has the highest agreement with markered motion capture. For markerless motion capture and IMUs, the lowest systematic bias was for sagittal plane joint kinematics. The red, green, blue, and depth camera had poor agreement with markered motion capture for each movement in both sagittal and frontal planes. From this study, researchers can begin to use markerless motion capture and IMUs for field studies with an understanding of the level of error associated with dynamic movements.Aim 3 implemented IMUs as a clinical tool to evaluate the effect of strenuous law enforcement training and repetitive head impacts on Timed-Up-and-Go (TUG) performance. The only significant difference in TUG performance was a reduction in average mediolateral acceleration during the turn between pre- and post-testing timepoints. This reduction may represent a more conservative movement pattern. The results of this study suggest that lateral dynamic stability is affected by fatigue rather than repetitive head impacts associated with strenuous physical training. There were no significant relationships between the number or magnitude of repetitive head impacts and TUG performance. The importance of physical fitness should continue to be emphasized for law enforcement officers.Findings from this research suggest that markerless motion capture and IMUs have the accuracy to be used to measure tactical athletes outside of the laboratory. Additionally, IMUs can be effectively used to evaluate the effect of training on movement patterns. Research should continue to evaluate tactical athletes’ movement patterns with motion capture in occupational environments to improve training practices and increase job preparedness.

This study contributes to a body of scholarship that demonstrates the benefits and need of employee-driven and defined wellness at work processes. This participatory action research study brought together a team of employees within a remote-work, start-up organization to define and design a process for implementing wellness at work for their organization. Through a participatory process that allowed outcomes to emerge from the group, employees identified opportunities to foster embodied wellness in their organization in three core areas: organizational, personal, and cross-boundary initiatives. Through a reflective collaboration, employees generated ideas and developed a plan to address employee-identified priorities that will foster wellness in their organization. What emerged from the process is a model for participatory health meaning-making called the Landscaping Wellness model that future practitioners and scholars may utilize to facilitate storytelling, idea generation, and planning processes for worker-defined wellness, thus honoring the nuanced and complex nature of wellness itself. This dissertation is available in open access at AURA (https://aura.antioch.edu/) and OhioLINK ETD Center (https://etd.ohiolink.edu).

Background & Purpose. Occupational stress and subsequent negative turnover are prevalent and severe issues within health and human service systems in general, and amongst child welfare workforces in particular. In addition to the psychological and physiological consequences for workers, occupational stress and related turnover can greatly impact child welfare organizations, as well as service delivery and family outcomes. Despite various efforts to address retention challenges affecting child welfare workforces, high levels of turnover continue to be a prevalent issue with costly familial and societal implications. The currently inconsistent evidence of turnover-reduction intervention effectiveness reflects a lack of consensus regarding the occupational levels and specific targets that should be involved when addressing workforce stress, organizational commitment, and related turnover. Therefore, the goal of this research project was to understand how multi-level occupational characteristics and experiences of the child welfare profession are associated with workforce recruitment and retention, while accounting for the unique internal and external factors salient to specific service system contexts. Methods. This research project was designed as a cross-sectional state-level case study of the Ohio child welfare workforce. Ohio is one of nine states with a state-supervised county-administered child welfare system, wherein specific policies and practices may range widely between agencies. A multi-level mixed methods approach was therefore used, as solely quantitative data may have failed to accurately capture work-related psychosocial influences. Specific data collection methods included: (1) assessing the local context through quantitative surveys and qualitative focus groups conducted with Ohio child welfare staff; and (2) analyzing administrative and secondary data regarding salient features of the child welfare occupational context (e.g., agency, county). Participant recruitment involved all employees working within a stratified random sampling of Ohio’s 88 county Child Protections Service Agencies (PCSAs). 245 staff from 20 PCSAs participated in the quantitative online study survey, 26 of whom agreed to participate in a subsequent study focus group. Results. Multivariate multiple regression, ANCOVA, and mixed-method analyses revealed that in addition to individual-level occupational influences (e.g., role characteristics), work-related environmental characteristics (e.g., agency features, community contexts), as well as professional perceptions and experiences can significantly affect employment responses (e.g., organizational commitment, turnover; p

Firefighters are vulnerable to adverse mental health outcomes in relation to cumulative occupational stress and trauma exposure. Emerging research suggests that mindfulness-based practices may be effective intervention strategies to reduce distress and trauma symptomology among firefighters. The purpose of this thesis is to assess the barriers, facilitators, and sample characteristics of an ongoing study to examine the effectiveness of a mindfulness-based stress reduction pilot program in reducing distress and trauma symptoms among firefighters. Nine firefighters enrolled in the mindfulness-based stress reduction pilot program and completed the pre-test survey. The sample was mostly male (66.7%; n = 6), white (88.9%; n = 8), non-Hispanic (88.9%; n = 8), 45 or older (66.7%; n = 6) and had 11-20 years of fire service (44.4%; n = 4). Major barriers to implementing the mindfulness-based stress reduction pilot program included: (a) recruitment tactics employed, (b) child-care considerations, and (c) Garmin vívosmart 4 complications; major facilitators to implementation included: (a) camaraderie, (b) session scheduling, and (c) accommodations. A benchmarking analysis revealed a nonsignificant difference in mean PSS scores, with the current study sample reporting slightly higher levels of perceived stress. A significant difference in mean PCL-5 scores was found in comparison to previously published scores, with the current study sample reporting higher levels of posttraumatic stress symptoms. Benchmarking analysis also revealed a significant difference in mean FFMQ-15 scores, with the current study sample reporting lower levels of dispositional mindfulness. Findings from this study support the potential need for an intervention like the present mindfulness program based on the sample’s reported posttraumatic stress symptoms and dispositional mindfulness. Further research is necessary to evaluate the effects of mindfulness-based stress reduction techniques on firefighter distress and trauma symptoms.

The study explores work-related musculoskeletal disorders in sonographers, focusing on the cardiac sonographers' lived experiences. The research shows that sonographers experience a high incidence of pain in their daily work, which affects their work and emotional well-being. This research aims to identify gaps in the existing literature concerning the lived experiences of cardiac sonographers, how they cope with the acquired pain and injuries, and how much of an impact WRMSD has on sonographer's everyday life. Sonographers are diagnostic medical professionals who perform tests to visualize the body's organs using ultrasound. Cardiac sonographers are specialized in visualizing and providing information about the patient's heart. WRMSD are injuries caused or aggravated by repetitive motions in the workplace.The study used a detailed descriptive approach to address the research question. A convenience sample of nine sonographers who experienced WRMSD participated in open-ended interviews and provided in-depth feedback on their lived experiences with WRMSD. The interviews were transcribed verbatim, coded, and analyzed. Atlas.ti Desktop Windows version was used for coding and analysis of data. Six major themes, two sub-themes along with six additional components of the sub-themes were found. Sonographers revealed the most important causes that trigger pain and also methods of coping with pain and injuries at work and in everyday life. The research based on the insightful description received from sonographers led to four important recommendations that would improve work conditions and decrease WRMSD.

The current study is quantitative research that used a web-based survey from multiple religious denominations in the United States to examine the relationships among perceptions of stress, work-family spillover, marital satisfaction, and family functioning of pastors. Emotional exhaustion, hours worked, personal accomplishment, and social support were analyzed as predictors from the work domain. Two measures of spillover were used to evaluate family stressors and enhancers. The stressors and enhancers were tested as mediators between work domain and personal/family life. Life satisfaction, marital satisfaction and family dysfunction were analyzed as outcome variables. The sample included 83 pastors from a convenience sample including 62 males and 21 females, with backgrounds diverse in culture, education, and denomination. Analyses were conducted using IBM SPSS (Version 26), including Pearson’s correlations along with regression analysis using PROCESS macro to test for mediation. It was found that social support does increase family enhancers and work-family positive spillover but contrary to predictions, personal accomplishment appeared to impact family life by increasing emotional exhaustion, stressors, and family dysfunctions. Greater incidents of emotional exhaustion and hours worked were found to reduce the incident of enhancers and work-family positive spillover and increase family stressors and work-family negative spillover. Greater incidents of emotional exhaustion were found to reduce marital satisfaction and increase family dysfunctions. This research has practical and clinical implications for pastors, spouses, and children of pastors, educators, family scientists, therapists, and organizations who employ pastors.

While severe mental illness (SMI) is extensively studied, less attention focuses on the relationship between people with SMI and their families and the impact this may have on treatment. Bronfenbrenner's (1979) ecological systems theory conceptualized the treatment and recovery of people with SMI and their families. This study proposes that if family members getting social support contribute to a person's treatment plan, the individual's treatment outcome will improve rather than the individual enduring the treatment process individually. By applying ecological systems theory, mental health professionals and policymakers can better grasp the systemic nature of individuals, their family members, and surrounding external circumstances. Future research implications and recommendations aim to increase knowledge and awareness of family involvement during SMI treatment approaches.

This multi-case study explored the well-being of six former preK-12 teachers during and after teaching. Using the framework of self-care, the purpose of this research was to investigate how teachers’ health, well-being, resilience, and other internal characteristics intersect with external factors of teaching and schools; accelerating teacher stress, burnout, and attrition. The major themes revealed included ineffectiveness and difficulty in early teaching careers; negative impacts/barriers to effective teaching and self-care; Covid impacts on teaching; school violence impacts on teaching; positive affirming experiences in post-teaching life, and finally issues/suggested policy changes. To address these negative impacts on teachers and the school community, leisure programming is presented as a pathway to personal development, to be paired alongside professional development.

Problem: Correctional nurses in the United States (U.S.) are known to work in inherently stressful environments due to the punitive nature of correctional facilities paired with staffing shortages, low resources, overcrowding, violence, and deteriorating living conditions of incarcerated persons. Prolonged and increased Job Stress may negatively impact the health and Wellbeing of those nurses that work within these environments. Poor Wellbeing leads to worse quality of life, impacted by poor sleep, anxiety, depression, and burnout. Additionally, Job Stress may adversely affect both patient and organizational outcomes, by impacting quality of care provided, increasing costs of sick days, and high turnover rates for facilities. The purpose of this manuscript format dissertation was to evaluate the impact that work has on the Wellbeing of correctional nurses through three distinct projects.Methods: Project 1 explored the current state of evidence regarding the correctional nurse working environment and identified causes of stress and burnout through an integrative review of the literature. Project 2 used a cross-sectional online REDCap survey of a sample of 270 U.S. correctional nurses to describe Organizational Characteristics (i.e., Job Demands, Job Control, Managerial Support, Colleague Support, Workplace Relationships), Job Stress, and Wellbeing levels in this group. Using the same dataset from Project 2 and guidance from the Job Demands-Resources Theory, Project 3 tested a model to determine the direct relationship between Organizational Characteristics and nurses’ self-reported Wellbeing through multiple linear regression modeling. Project 3 also explored the mediating effect of Job Stress on the relationship between correctional Organizational Characteristics and correctional nurse Wellbeing through structural equation modeling. Findings: Project 1 included analysis of 11 articles that met inclusion criteria. Results revealed Job Stressors of conflict, fear, and demands across nurses in varying correctional environments. Project 2 revealed moderate Job Stress (M = 16.26, SD = 7.14) and Wellbeing levels just below the risk for adverse events (M = 1.8, SD = 3.06) among U.S. correctional nurses. Lower organizational characteristic scores were noted for Managerial Support (M = 3.13, SD = 0.35) and Job Demands (M = 3.56, SD = 0.922). Registered nurses and those who worked in U.S. prisons had the highest Job Stress and worst Wellbeing levels. Project 3 results included evidence of a good model fit. There was a significant, direct impact of Job Demands, Job Control, relationships, and Job Stress on Wellbeing. Job Stress also significantly mediated the effect of Job Control and Job Demands on Wellbeing.Conclusion: Results have uncovered stressors of conflict, fear, and demands in the correctional nursing environment. Such stressors may contribute to the overall prevalence of moderate Job Stress and varying Wellbeing levels across different groups of correctional nurses. The study’s conceptual model advances what is known about how Job Demands, Job Control, Workplace Relationships, and Job Stress impact the Wellbeing of U.S. correctional nurses. This work is an essential next step in promoting healthy workspaces, urging the need for further exploration to inform what targeted interventions may help to reduce Job Stress and improve Wellbeing for U.S. correctional nurses.

Organizations in the motor vehicle body manufacturing industry continue to see workplace injury persistence. Evidently, the current execution of industry accepted proactive safety models are ineffective, driven by the lack of applied leadership concepts. A mixed-methods insider participatory action research approach was taken utilizing a synthesized Leadership Questionnaire (LQ) and semi-structured interviews. A total of 177 participants completed the LQ and 9 participants were interviewed. The data indicated relationships between leadership concepts, safety performance and an understanding of proactive safety, organizational prioritization, and leadership safety influence. These results informed a detailed action plan framework, the Sustainable Safety Leadership Plan (SSLP), for organizational deployment. The objectives of the SSLP framework are a precise SSLP training workshop, community proactive safety feedback loop establishment and launch of a single proactive safety key performance indicator (KPI).

Complex epidemiological questions cannot be addressed with individual level analyses, but insights can be gained from aggregation and spatial methods. In this dissertation, I conducted three different epidemiological analyses in which spatial methods provided new insights to challenging questions. By using fine scale spatial methods and leveraging Bayesian statistics, I uncovered relationships between the physical, social, and infectious environment. In aim 1, I identified the relationship between cumulative P. falciparum burden and endemic Burkitt Lymphoma (eBL), the most common pediatric cancer which is fatal if untreated. I employed spatial estimates of annual P. falciparum burden to calculate lifetime P. falciparum infections for birth cohorts across three regions of Kenya, Uganda, and Tanzania to overcome the logistical and biological challenges of measuring an individual’s asymptomatic infections. After identifying a weak spatial correlation between the cumulative burden and eBL, I identified the relationship between endemic Burkitt lymphoma and lifetime P. falciparum exposure by region, age, and sex. I demonstrated that for every 100 lifetime P. falciparum infections, the risk of eBL increases 39% (95% CI: 6.1% – 81.0%) and this risk is greater among males and children between the ages 5-11. In aim 2, I used Michigan mortality records from January 2015 – November 2019 to predict the expected mortality from both acute respiratory infections and all other causes. I divided the pandemic period into distinct temporal periods from December 2019-November 2022 based on the strength of non-pharmaceutical interventions, vaccine availability, COVID-19 specific pharmaceutical treatments and shifts in dominant SARS-CoV-2 variants and compared the observed cause-specific mortality rates to the expected. Excess mortality from both ARI and non-ARI causes peaked during the first wave of the pandemic at 16.1 (13.44 -19.38) and 1.49 (1.43 – 1.55) excess deaths per expected deaths, respectively, and census tract level excess mortality rates are heterogenous across the state. Excess mortality, an aggregate metric with no analogous individual measurement, quantifies burden missed through traditional surveillance. In aim 3, I modeled the relationship between soil dust and drought, parameterized via the Standardized Precipitation Evapotranspiration Index with a 2-month lag (2-month SPEI). Exposure to soil dust has significant health burdens and is expected to increase under climate change. Using our modeled relationship between soil dust and 2-month SPEI, I estimated the future soil dust burden under climate change scenarios (Shared Socioeconomic Pathways; SSPs): SSP 2, a mild emissions scenario, and SSP 5, a more extreme emissions scenario. For every one unit increase in 2-month SPEI, indicating wetter soil, annual soil dust burden decreases 19.5% (95% CI: 19.4% – 19.6%). Under both climate change scenarios, overall dust burden is expected to increase in 2045-2055 and 2090-2100 and 243 (95% CI: 146-292) additional annual all-cause mortalities, 2913 (95% CI: 2334-3484) additional annual incidences of Alzheimer’s disease, and 356 (95% CI: 161-549) additional annual incidences of dementia. Using projected population projections at the county level, the expected increase in dust-mediated health outcomes is even greater. To summarize, the aims of this dissertation exemplify epidemiological questions that cannot be addressed with individual measures of exposures or outcomes, providing approaches to urgent problems in global and domestics infectious disease epidemiology. I hope this work inspires greater consideration for the application of spatial methods in situations where these methods are typically not utilized to examine the complex relationship between the environment and health.

Structure fires encompass organic and inorganic fuel sources from both natural and synthetic materials. Incomplete combustion of these materials harvests several hundred byproducts including volatile organic compounds (VOCs) and polycyclic aromatic hydrocarbons (PAHs). Firefighters are required to wear a certified National Fire Protection Association personal protective equipment (PPE) ensemble. In recent years, new and more advanced PPE control measures have been introduced (i.e., interface control measures, particulate-blocking materials, and the utilization of base layer clothing worn underneath the ensemble) with the intention of attenuating the ingress of known carcinogens to the inside of the gear. Providing interface control measures and adding particulate-blocking materials appeared to provide a protective benefit against less-volatile chemicals, like naphthalene and styrene. Using a fireground exposure simulator (FES), this mannequin-based study evaluated the effectiveness of four different PPE conditions with varying contamination control measures (incorporating PPE interface design features and particulate blocking materials) to protect against ingress of volatile and semi volatile contaminants in a smoke exposure chamber. Furthermore, we investigated the effectiveness of long-sleeve base layer clothing to provide additional workplace protection against skin contamination. Outside gear airborne concentrations were collected within the smoke exposure chamber. Personal air concentrations were collected from mannequins under PPE at the breathing zone, abdomen, and thigh heights and under the base layer at the abdomen and thigh heights. Sampled contaminants included benzene, toluene, styrene, and naphthalene. Workplace protection factors (WPFs) for all compounds were lower under hoods and jackets compared to under pants. Observed across all four conditions, median WPFs increased from the hood and jacket down to the turnout pant. We also evaluated varying levels of protective hood interface and particulate-blocking features. We assessed the efficacy of the hoods against the ingress of naphthalene. Additionally, we explored the effectiveness of a 100% cotton turtleneck at further attenuating the amount of naphthalene reaching the surface of the mannequin’s neck. Bulk base layer and under base layer filter samples were collected from the neck region of the mannequins and analyzed for PAHs. Naphthalene existed primarily in the vapor phase. A larger percentage of naphthalene was collected on the PTFE filter under the traditional knit hoods than on the cotton base layer, suggesting a small protective effect of the base layer.Results indicated that chemical volatility played a major role in terms of ingress or breakthrough capabilities. Interface control measures and particulate-blocking materials for the ensemble provided more protective effects against less volatile contaminants. Thus, the more volatile contaminants readily penetrated the standard PPE ensemble. Primarily, contaminants in the vapor phase penetrate the protective barriers of the firefighting PPE ensemble. Specifically, naphthalene has breakthrough tendencies to the interior of the protective hood, even those designs with more advanced PPE controls. Overall, having a more intricate understanding of sampling efficiency, exposure pathways, and efficacy of the studied PPE controls is crucial for advancing firefighting PPE technology and reducing occupational exposures to the U.S. Fire Service.

As the COVID-19 pandemic continues into a third year, estimates of the proportion of Americans that have been infected at least once range from 42-60%, and an estimated 6% of U.S. adults are currently experiencing the effects of long COVID. The pandemic has uniquely stressed workers in many sectors considered essential, from healthcare workers and first responders to farm workers, retail workers, and manufacturers. This dissertation aims to understand whether and how the impacts of COVID-19 are associated with occupation in the context of Los Angeles (LA) County, California. After an introduction to COVID-19 and its impacts on population mental health and on essential workers, Chapter 2 presents an ecologic analysis using data from the U.S. Census American Community Survey and the LA County Department of Public Health. This analysis examines if LA County communities with a higher share of their workforces in specific occupations (healthcare, first response, education, or food service) were more or less impacted throughout the COVID-19 pandemic. A higher proportion of a community’s workforce employed in healthcare or education was associated with lower COVID-19 impact, while a higher proportion of a community’s workforce in first response or food service was associated with higher COVID-19 impact.Chapters 3 and 4 use data from a longitudinal cohort study of COVID-19 infection risk in LA-based healthcare workers and first responders to conduct longitudinal analyses on risk factors associated with infection risk and mental health outcomes between May 2020-Sept 2021. Nurses had higher odds of anxiety and of trauma response compared to physicians. Moderate and high levels of hospital bed occupancy were associated with higher odds of low resilience compared to a low level of bed occupancy, but were not associated with anxiety level or trauma response. Infection risk, vaccination rate, and mental health outcomes differed between healthcare workers and first responders. Time since study baseline was associated with most mental health outcomes across models, but the relationship is nuanced. Finally, Chapter 5 discusses the public health implications of the research, including potential polices and interventions that may better protect the physical and mental health of workers across the economy.

SUMMARY ABSTRACTBackground: Across the Department of Veterans Affairs (DVA), a position titled Reasonable Accommodation Coordinator (RAC) has primary duties focused on processing employee requests for disability-related reasonable accommodation/personal assistance services (RA/PAS). Historically, clinically trained positions such as vocational rehabilitation counselors, physical/occupational therapists, nursing, and social work have served in similar roles to support return-to-work processes. It was assumed that most DVA RACs hold credentials in human resources (HR)-related fields of study but may benefit from having knowledge and skills in clinical content service areas. Furthermore, civil rights complaints filed for alleged discrimination based on disability highlight potential shortcomings with the DVA request for RA/PAS process, which may stem from RAC-related factors and/or gaps in RAC training, knowledge or practice. There is no standardized training to become a DVA RAC, and a paucity of research on administrative personnel who support workplace disability management practices. This research provides insight on the impact of multiple factors, including DVA RAC credentials on practice, belief, and knowledge, as well as identify RAC training and professional developmental needs. Methods: A cross-sectional study was conducted using a semi-structured survey administered to 109 DVA RACs. Results: With respect to tasks that are routinely a part of the process for employees who request RA/PAS, overall RACs with clinical credentials report greater frequency of practice, rate higher degree of importance for tasks, as well as higher levels of knowledge and confidence, however not all findings were statistically significant. Conclusion: The request for RA/PAS is a complex process that is influenced by psychosocial and system elements. Training on communication skills and understanding the impact of receiving RA/PAS for employees with disability, is especially needed for RACs with HR/administrative credentials, although continuous learning opportunities should be made available to all DVA RACs in the content areas of statutory knowledge and service delivery. Four categories of recommendations have been outlined, including skills training/professional career development, RAC position standards/conditions, multi-faceted partnership opportunities and system/organizational considerations.

Purpose: The purpose of this study was to assess knowledge and concern of workplace health risks and safety among US pediatric dentists and detect any significant demographic associations. A secondary aim was to identify the sources of education on this topic and recognize areas for improvement in occupational health risks education.Methods: An anonymous electronic survey via REDCap (Research Electronic Data Capture) was sent to 7009 US pediatric dentist members of the American Academy of Pediatric Dentistry. Demographic data was collected along with level of knowledge and concern about fourteen listed occupational risks. A logistic regression was performed and associations between responses and demographics were analyzed. Odds ratios were calculated with a 95% confidence interval and statistical significance set at P = 0.05.Results: 453 completed surveys were received for a response rate of 6.46 %. Respondents are more knowledgeable about well-researched and documented workplace risks such as those from blood-borne pathogens, radiation and nitrous oxide but less knowledgeable about recently highlighted risks of fitted masks and disinfectants/cleaning solutions. Pediatric dentists are most concerned about the effects of poor posture on their musculoskeletal health followed by work-related stress, work-life balance stress and operatory noise levels. Top concerns for staff’s health mirror the same risks as those for provider’s health. Providers reported that their sources of education on workplace safety and risk mitigation were self-guided study and research (79.5%), CE courses (75.7%), pediatric dentistry residency (54.7%) and dental school (48.6%). Almost all dentists surveyed (96.5%) believe that education about occupational risks should be incorporated in dental school and residency education curricula. Limitations of the study include a low response rate, and possible lower reported concern levels with workplace safety after the more robust safety protocols implemented during the pandemic.Conclusion: 1. Females showed significantly more concern about the effect of various workplace health risks on both their own health and the health of their staff, who were mostly female. 2. Employee/associate pediatric dentists and those who work in an academic practice showed significantly more concern than owner/co-owner colleagues about the effects of various workplace health risks on their own health and the health of their staff. 3. The most commonly reported source of information on workplace risks and risk mitigation was self-guided study and research followed by CE courses, which demonstrates provider interest in these topics and the need to incorporate education on these topics during dental school and residency.

Home healthcare workers (HHCWs) are exposed to numerous hazards within the patient's residence. These workers have no control over residential workplace hazards such as safety, chemicals, second-hand smoke, biohazards, and bioaerosols, which are all contingent on a given home and its environmental conditions. Examples of bioaerosols include bacteria, fungi, pollen, and viruses. Currently, there are no occupational health and safety regulations for HHCWs employed in patient homes; however, such provisions are published for healthcare settings such as hospitals. Unfortunately, exposure assessment is challenging due to the nature of HHCWs job duties as well as cross-contamination, cost, and instrument operation requirements. Therefore, the development of a practical approach to collect and interpret data to predict and prevent bioaerosol exposures to HHCWs is required. This dissertation aimed at understanding how home healthcare workers are exposed to bioaerosols and what types of bioaerosols are present within a residence during everyday activities. Bioaerosol concentrations were measured in different ventilation, spatial, and temporal conditions using a novel technology: a fluorescence-based direct-reading instrument (InstaScope, DetectionTek, Boulder, CO, USA). The effect of seven activities of daily living (bedsheet changing, cooking, dusting, showering, sleeping, vacuuming, and walking) on bioaerosol generation was studied. Higher concentrations of pollen and fungi were consistently measured compared to bacteria. Further, the concentrations of fluorescent particles were higher than non-fluorescent particles. Showering, cooking, and bedsheet changing experiments were found to have increased bioaerosol concentrations compared to dusting, sleeping, vacuuming, and walking. Next, PM10 and PM2.5, both categorized as total and biological particles, were investigated. The objective was to characterize the spatial and temporal variation of bioaerosol concentrations, coupled with experimentally controlled ventilation modes (natural and mechanical HVAC) within a home to mimic home healthcare working environments. The multi-factorial ANOVA method indicated that there were significant and meaningful differences in the mean concentrations within the seasons and rooms for each particle type. Lastly, the variation in PM concentrations between 32 different possible working environments (during different seasons, rooms, and with controlled ventilation modes) was examined. The highest PM concentrations across all particle types occurred in the bedroom and bathroom during the spring and summer seasons. On the contrary, the lowest PM concentrations across all particle types were observed in the kitchen and bathroom during the winter and fall seasons. Based on these results, environments with the bedroom yielded the highest PM concentrations. Similarly, bioaerosol concentrations were increased during bedsheet changing experiments, which occurred in the bedroom. Environments with the bathroom also yielded higher PM10 biological and total concentrations. Similarly, bioaerosol concentrations were increased during showering experiments, which occurred in the bathroom. It is recommended that employers pursue the hierarchy of controls when HHCWs work within these seasonal and spatial parameters. This dissertation provides baseline data regarding bioaerosol concentrations during activities that home healthcare workers commonly encounter. Further, future experiments should be conducted within real patients’ homes during HHCWs’ work shifts. Lastly, this dissertation opens future research on occupations in similar exposure groups such as law enforcement and other emergency services such as firefighting.

Presenteeism is working while sick as a performative measure, despite the risk of disease transmission or adverse consequences. Little is known about presenteeism in the dental hygiene profession. This study aimed to identify current work practices related to presenteeism in practicing dental hygienists in the United States. Demographic data and work-practice factors that can significantly relate to presenteeism among dental hygienists were collected to identify attitudes and beliefs before and during the Covid-19 pandemic. Methods: Participating dental hygienists completed a 30- question survey about working while sick before and during the COVID-19 pandemic. To measure elements of presenteeism the survey contained the following: questions about demographics, practice type, debt, and work-practices. These included personal reasons of financial concern, age, level of experience, perceived social influence of colleagues and patients, and ostracism, status of employment, and organizational factors, such as management and leadership, policy, and culture. The survey was adapted from a previous survey of physicians and advanced practice clinicians. The survey was accessed through the online platform Qualtrics XM application. Participants were recruited via professional social media groups. Data were analyzed using descriptive statistics and multivariate logistic regression. Results: Outcomes from this study identified presenteeism in dental hygienists and factors influential to why they work when sick. Eight hundred forty-three participants from 48 states completed the survey. Seventy-nine percent of dental hygienists worked when sick at least once the year preceding the pandemic. Those who worked with cold symptoms and other contagious illnesses during that year were under the age of 40 (p=0.03), two hygienists were employed in their primary place of employment (p=0.02) and worked 13+ days/month. 49% of dental hygienists worked when sick at least once during the pandemic. Those who worked with cold symptoms and other contagious illnesses during that year were over 40 years of age (p=0.02) and had a greater than $80,000 in education loan debt. Dental hygienists with 11-20 years of practice experience (p=0.03), an hourly wage compensation mechanism (p=0.03), and an education debt level of $20,000-$30,000 (p=0.02) believed working when sick endangers patients and colleagues. Conclusion: Personal factors, job characteristics, and organizational factors contribute to dental hygienists working when sick. Additionally, this study indicates the need for a paradigm shift in occupational safety and well-being to support dental hygiene practitioners, colleagues, and the patient population they provide care for.

Background: Firefighter fatalities from heart attacks or sudden cardiac deaths (SCD) are the number one cause of on-duty firefighter deaths. With more than 1.1 million firefighters working in the United States, lack of routine monitoring of firefighters engaged in strenuous activities could result in the delayed early detection of cardiopulmonary compromise that warrants further medical evaluation. It is imperative for occupational health professionals and firefighter leadership to develop practical and cost-effective strategies facilitating early detection of cardiopulmonary distress in on-duty firefighters. Performing research during firefighting activities may lead to identifying effective real-time monitoring strategies leading to early detection and application of early interventions reducing or eliminating on-duty firefighter deaths due to cardiopulmonary issues.Aim: The aim of this dissertation research is to advance knowledge about using practical approaches, such as exploring exertion perception and monitoring vital signs variability, as surveillance techniques to assess for early signs of cardiopulmonary stress while firefighters are on-duty. Methods: For this manuscript-based dissertation, three interrelated manuscripts were completed. Manuscript one was a systematic review of existing literature to explore the relationship of Borg rating of perceived exertion (RPE)® scale and heart rate in firefighters. Two data-based manuscripts were constructed on data gathered during an exploratory, descriptive study conducted with 19 firefighter participants. Using an observational repeated measures design, four time points of data were collected from each participant under the two conditions (firefighter fire house activities and live-burn training activities). Manuscript two was an exploration of vital sign variability within and between the two conditions. Manuscript three was an exploration of vital sign variability in relationship to cardiopulmonary risk factors. Box plots interquartile ranges and scatterplots with regressions lines were used to visually explore data variability and relationships for both data-based manuscripts.Results: The systematic review found 11 articles of which three were high quality, three middle quality, and five of low quality. Eight studies reported evidence of a positive correlation between Borg RPE® scale and heart rate. Visual results in manuscript two showed that vital signs variability increased during live-burn training. Manuscript three results showed the increase in vital signs variability, which occurred during live-burn training, demonstrated the most dramatic visual increases in relationship to increased age and increased body mass index.Conclusion: To advance knowledge on potential early detection and monitoring strategies of increased cardiopulmonary stress in firefighters, three interrelated manuscripts were completed. Collectively, findings from all reflect a need for consistent and routine vital signs monitoring in the field with a focus on major risk factors such as age, modifiable risk factors such as body mass index, as well as, use of Borg RPE® scale to monitor firefighters’ perceived exertion. These strategies should be considered for integration into firefighter medical surveillance programs, which may require that these surveillance programs be reconfigured to include more frequent monitoring using a tiered approach.

Autonomous nurse practitioners are an effective and useful member of the healthcare team, particularly when given a less restrictive scope of practice at the state level. The autonomous nurse practitioner can help improve patient outcomes/needs as a decision-making health care team member. Ohio nurse practitioners treating worker’s compensation patients are limited in treating the injured worker not because of the nurse practitioner scope of practice, but because of the bureaucratic paperwork worker’s compensation requires of its patients/providers. The purpose of the project was to conduct a needs analysis regarding a legislative change proposal for the practice authority of nurse practitioners treating the Ohio worker’s compensation patient. This quantitative study was completed by conducting chart reviews of worker’s compensation patients evaluated by the nurse practitioner evaluating any disparities between work restrictions recommended by the nurse practitioner versus the physician. The target population for this study included nurse practitioners treating Ohio worker’s compensation patients in the Occupational Medicine setting. Patient chart reviews were conducted, reviewing the work restriction instructions given by the nurse practitioner and included only initial injury evaluation patients that had a required Medco-14 form. The charts were randomly selected from the past schedules of the two practicing occupational nurse practitioners in a rural Ohio county. Of the 70 random charts reviewed, 100% had no discrepancies between the nurse practitioner work recommendations and that of the physician. Allowing nurse practitioners to sign Medco-14 forms will increase patient access to care, which in turn results in better patient outcomes.

The (mis)application of mainstream psychological theories and methods of analysis further perpetuates oppression (specifically misogynoir) while suppressing the unique and diverse experiences of Black women. This study implemented a methodological framework rooted in Black feminist, phenomenological, and anti-oppressive theories to more holistically explore the meaning of pleasure in Black women's lives. Pleasure was defined and positioned as a restorative strategy in participants’ liberation efforts, using psychopolitical well-being as a grounding construct. Results reveal personal, relational, collective, and multi-spherical pleasure practices that helped participants challenge oppressive socialization, divest energy from oppressive industries, and receive relief from suffering. Findings hold implications for social justice oriented research, intervention, and policy development intended to facilitate well-being among Black women. Further, results provide rationale for future pleasure-centered scientific inquiry needed to address the “pleasure deficit” in understandings of Black womanhood. Ultimately, this project intends to strengthen the lens through which professionals understand Black women’s wellness by providing data on what makes them feel whole, alive, and free.

Interpersonal Neurobiology (IPNB) is an interdisciplinary, science-based field that seeks to understand human reality including the nature of mind, brain, and relationships. IPNB has been used extensively by mental health practitioners as well as child development and parenting experts. While practitioners and scholars have described ways that IPNB can be used in leadership and organizations, there has been no systematic inquiry into the practical and phenomenological experience of this application. IPNB offers an alternative to dominant models of care and leading in healthcare settings and fields, which are characterized by disconnection, objectification, and separation. It offers a relationally centered approach that honors people’s subjective experience and seeks to advance whole-person and whole-system wellness through the promotion of integration. As a living and dynamic systems approach, IPNB has the potential to influence the quality of leaders’ presence, perception, and practice while upholding the interconnectedness within and between the functional elements of organizational structures and processes. This narrative inquiry sought to explore how leader and leader consultants approach their work from an IPNB perspective. It centers around two research questions: How, if at all, have healthcare leaders integrated IPNB in their leadership practices, and what impact has this integration had on their development and identity? Secondly, what, if any, implications might their experiences hold for leadership in health and mental health organizations? Using the Listening Guide (LG; Gilligan, Spencer, et al., 2006) methodology this inquiry explores the experiences of twelve leaders and leadership consultants in order to understand the implications IPNB has had for their practices, development, and identity. It takes a broad and deeply phenomenological dive into each person’s IPNB leadership experience across time, space, and place to understand the implications this framework has had for leading and organizations. This inquiry identifies what themes and IPNB principles have been significant to the participants, the counterpoints that have propelled their development forward, and the multiple and relationally positioned identities that signify leader’s relational embeddedness in the organizations and systems they serve. This dissertation is available in open access at AURA (https://aura.antioch.edu) and OhioLINK ETD Center (https://etd.ohiolink.edu).

In recent years, HABs have been affecting the quality of drinking and recreational water in many areas around the United States. Current and accurate information sharing is imperative, with the potential of HABs to have a more significant impact on the health and well-being of vulnerable populations. In contrast, individuals may amplify the risks of HABs where no problem exists, caused by the spread of inaccurate information. More effective communication can supply individuals with the information necessary to make an informed judgment of risk, potentially reducing the health and economic impacts of HABs. Understanding an individual’s risk perceptions related to HABs can impact how reliable and accurate information is communicated to the public. The purpose of this study was to 1) identify if residents and workers perceive algal blooms as a concern; 2) determine how information about HABs is communicated; 3) find whom residents and workers perceive as trustworthy; 4) determine how residents or workers change behaviors because of HABs. An online survey was used to collect information about residents’ perceptions of water quality in northwest Ohio in October and November 2021. Of the 258 survey participants, the majority were white females between the ages of 18 to 29 years. Out of the group of total participants, a subgroup of 44 participants that work on or near water in northwest Ohio was used to better understand perceptions of workers potentially impacted by HABs. Nearly 50% of participants perceived HABs as a risk to health and a greater number of participants perceived HABs as a problem in the Western Lake Erie basin (65.5%). The media and broadcast news were recalled most as the organization providing HABs information (53.9%), whereas a higher percentage of the workers recalled the health department as the information source (59.1%). A wide distribution of trust was presented among all sources; however, workers had less trust in the scientists/researchers than the total group of participants. Avoiding the use of water recreationally, buying bottled water, and avoiding household water are behavior changes that occur when HABs are present or because of past HABs in the region. HABs have an impact on the population in affected areas by causing behavior changes and altering perceptions of water quality. Based on the results of this study, understanding how residents perceive risks related to HABs can better inform stakeholders, policymakers, and the media on effective risk communication.

Work values influence job choice and satisfaction (Pataki-Bittó & Kapusy, 2021). Workplace hazards can lead to physical or mental harm (Cabeças, 2015). This study investigated generation Z’s perception of workplace hazards and how safety relates to intrinsic, extrinsic, social, and career work values. The effects of past workplace accidents and safety training were investigated. This study was done through a survey distributed to Ohio University students through Qualtrics. It targeted generation Z students who have recently or will soon graduate and intend to work in an office environment. Each work value was rated as “very important” or “extremely important” overall. When forced to rank, extrinsic values ranked most important, while safety ranked least important. Ergonomic hazards were believed to be the most encountered. Protection from environmental hazards was seen as mostly the employer’s responsibility, while the responsibility of hazard protection was expected to be shared equally between employee and employer for all other hazards. Prior safety training did not seem to affect any responses, while workplace accident history affected the responses for some work values, and how responsible employers should be for ergonomic hazards. Limitations of this research include the sample size (32), skewed gender populations, and focus on a single occupation. Further research in this field will be important to understanding the wants and needs of this generation in any workplace.

Esports is a rapidly growing sport, with serious competitions available at the collegiate and professional levels. There are few studies about the health and wellness of esports players, and almost none concerning the effects of ergonomics. However, there are many ergonomics studies conducted about an environment similar to an esports athlete’s workstation—the office environment. The aims of this study were to assess the utilization of ergonomics in the collegiate varsity esports environment and to create some relevant characterizations. Data was collected using a survey distributed online to potentially eligible candidates. Results found that a university’s ergonomic support, ergonomic quality of equipment, or an esports director’s involvement with ergonomics had no associated effects on one another and that program lifetime had no relationship to the ergonomic support provided by the university. Musculoskeletal disorder risk was shown to be possible, with most discomforts reported being in the upper body, and responses about student behavior in the provided practice space showed promise that university support for ergonomics would have direct impact on student athletes. This study was limited by the lack of a centralized database of competing universities and the low number of responses received. The study has shown the need for more research and created results to be compared for future studies to compare to.

Pharmaceutical interventions (PI) and non-pharmaceutical interventions (NPI) are relevant for controlling and mitigating the transmission of respiratory tract infectious diseases such as influenza and COVID-19. The impact of these strategies on children, workers, and low-middle-income countries was explored (chapter 2-6). Chapter 2 used a scoping review to describe the application of digital technology in improving hand hygiene among children in educational settings. Three main types were identified, including computer games (n=2), videos (n=8), and video cameras (n=2) which were found to be effective when used over a short time. Chapter 3 was a systematic review to assess the evidence of economic evaluations against influenza among workers or the workplace setting. Out of the twenty-four articles included, 21 were cost-benefit analyses, and 23 used PIs (primarily vaccination). All but two studies reported that interventions at the workplace were cost-saving and cost-effective. Chapter 4 characterized the transmission dynamics of COVID-19 in Ghana by estimating the time-varying reproduction number (Rt) at the national and regional levels using publicly available data from March 2020 to December 2021. The association between Rt and implemented interventions was also explored. Ghana experienced four pandemic waves with epidemic peaks in July 2020 and January, August, and December 2021. The epidemic peak was the highest nationwide in December 2021, with Rt ≥2. Rt decreased from above 1 when schools reopened in January 2021 to below 1 after vaccination rollout in March 2021. Chapter 5 utilized a homogenous-mixing compartmental model to simulate the transmission dynamics of COVID-19 and assessed the impact of increasing vaccination rate to achieve 50% coverage. The findings suggest

The thesis examines the system of occupational health and safety in France. It analyses the use of expert manpJwer in the field with a view to establishing the pJssibility of a profession in health and safety. An input-output model is developed to bring together the necessary elements of prevention of accidents and occupational diseases. The role of institutions concerned with health and safety is analysed with reference to this model. The research establishes the need for a health and safety specialist role. The recognition and status of this role are found to be subject to other criteria including the acceptance by institutions of such a specialist role. The model is also used to define the role of this specialist as expected by the various institutions intervening in the field.

Nickel is frequently reported as an agent causing allergic contact dermatitis in humans and was selected as an example for the investigation into the molecular mechanisms of the sensitivity. Nickel, as a hapten, may not constitute the complete antigen. The protein of cellular conjugates of nickel formed in the skin may represent the antigenic complexes, but the number and nature are unknown. In this submission, allergic contact dermatitis to nickel is reviewed; data on the immunological processes from various human and animal-model systems relevant to this problem are appraised and experimental investigations into the antigenic complexes of nickel are described. The albino guinea-pig was selected as a suitable animal model and a test system was developed to induce and elicit allergic contact dermatitis to nickel in this species. Under the exposure conditions of this system, an incidence of the sensitivity of 70-100% in a test population was experimentally induced. This consistently high incidence was not achieved by the use of standard published animal methods. Time-coursed In vivo exposure studies, employing 63NiCl2 as a radiotracer, were performed to qualitatively and quantatively examine the absorption and accumulation of nickel in the skin. The results indicated that soluble nickel salts are poorly absorbed across the skin. Maximum plasma levels were seen after 12 hours of exposure, although these represented only a very small percentage of the appled nickel salts (0.06%). Absorbed nickel was excreted in the urine. Microautoradiography of in vivo exposed skin indicated that transappendageal passage may be the main route of entry into the body. Accumulation of nickel was apparent in the highly keratinized areas of the skin, and labelling of basal and supra-basal epidermal cells was observed. Dermal accumulation was not seen. Fractionation of the in vivo exposed epidermis by zonal ultracentrification and gel filtration revealed four main areas of nickel localization. It was found associated with a microsomal fraction, with albumin, with an epidermal protein fraction (molecular weight 8,700) and with low molecular weight (< 5,000) residues. The antigenicity of each isolated nickel-containing fraction was assessed by in vitro lymphocyte transformation. The primary antigens in this system were the epidermal protein fraction (molecular weight 8,700) and the microsomal fraction. The low molecular weight residues possessed some very weak antigenic properties. Allergic contact dermatitis appears to be a complex sensitivity reaction to more than one antigen in the skin. The recognition of antigen by the immune system is protein-carrier dependant and the processing of haptenic or antigenic information by microsomal constituents may be an importanat function in the induction phase of the dematitis.

The research objectives were:- 1.To review the literature to establish the factors which have traditionally been regarded as most crucial to the design of effectlve exhaust ventilation systems. 2. To design, construct, install and calibrate a wind tunnel. 3. To develop procedures for air velocity measurement followed by a comprehensive programme of aerodvnamic data collection and data analysis for a variety of conditions. The major research findings were:- a) The literature in the subject is inadequate. There is a particular need for a much greater understanding of the aerodynamics of the suction flow field. b) The discrepancies between the experimentally observed centre-line velocities and those predicted by conventional formulae are unacceptably large. c) There was little agreement between theoretically calculated and observed velocities in the suction zone of captor hoods. d) Improved empirical formulae for the prediction of centre-line velocity applicable to the classical geometrically shaped suction openings and the flanged condition could be (and were) derived. Further analysis of data revealed that: - i) Point velocity is directly proportional to the suction. flow rate and the ratio of the point velocity to the average face velocity is constant. ii) Both shape, and size of the suction opening are significant factors as the coordinates of their points govern the extent of the effect of the suction flow field. iii) The hypothetical ellipsoidal potential function and hyperbolic streamlines were found experimentally to be correct. iv) The effect of guide plates depends on the size, shape and the angle of fitting. The effect was to very approximately double the suction velocity but the exact effect is difficult to predict. v) The axially symmetric openings produce practically symmetric flow fields. Similarity of connection pieces between the suction opening and the main duct in each case is essential in order to induce a similar suction flow field. Additionally a pilot study was made in which an artificial extraneous air flow was created, measured and its interaction with the suction flow field measured and represented graphically.