Search

The continuing launch of innovative but high-price drugs has intensified efforts by payers to manage use and spending and by pharmaceutical manufacturers to support patient access and sales. Payers are restricting drug formularies, requiring more stringent prior authorizations, and raising patient cost-sharing requirements. Manufacturers are investing in programs that help patients and physician practices navigate administrative controls and help patients meet cost-sharing obligations. Based on a compilation and analysis of the existing peer-reviewed and professional literature, this article estimates that payers, manufacturers, physicians, and patients together incur approximately $93.3 billion in costs annually on implementing, contesting, and navigating utilization management. Payers spend approximately $6.0 billion annually administering drug utilization management, and manufacturers spend approximately $24.8 billion supporting patient access in response. Physicians devote approximately $26.7 billion in time spent navigating utilization management, whereas patients spend approximately $35.8 billion annually in drug cost sharing, even after taking advantage of manufacturer and philanthropic sources of financial support. All stakeholders in the US pharmaceutical system would benefit from a deescalation of utilization management, combining lower drug prices with lower barriers to patient access.

Introduction: Most of the initial focus in handling COVID-19 had been based on avoiding exposure by refraining from rendering most treatments other than those considered an emergency or urgent. Post-lockdown, with the resumption of most activities, there has been concern over the possibility of transmission scenarios if sufficient care is not taken. The control and prevention of the spread of infections when elimination of exposure is not possible is chiefly achieved through the judicious use of engineering controls and administrative controls in a clinical setting in addition to the standard protocols and transmission-based protocols. True safety lies in being one step ahead. There have been mentions of the possibility that COVID-19 could be opportunistic airborne in its spread, in addition to being spread via saliva, droplets, and contaminated surfaces or objects. Method: A literature search of PubMed, Google Scholar, Cochrane Library, and advisories released by such organizations as the World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), Ministry of Health and Family Welfare (MOFHW), European Centre for Disease Prevention and Control (ECDC), Chinese Center for Disease Control and Prevention (China CDC), American Dental Association (ADA), Canadian Dental Association (CDA), French National Dentists Association, Dental Council of Belgium, National Health Service, England (NHS UK), National Health Service Scotland (NHS Scotland), and International Society for Infectious Diseases (ISID) was performed, with search parameters aimed at gathering information pertaining to infection control and cross infection control in dental settings as related to orthodontics. Result: There have been numerous articles and advisories published over the last 20 years, but the main focus has been on safe practices and to an extent on personal protective equipment, with relatively less emphasis on the need for respiratory protection by way of engineering controls and administrative controls. This review highlights the engineering and administrative controls that can be put into effect to make infection control and prevention much more effective. Conclusion: Any health care facility must be able to prevent, contain, and control infections with no risk of nosocomial infections. For this, an assumption has to be made that every individual in a health care setting is either at risk or a risk, depending on whether the person is infected or not. Meticulous attention to stringent policies of hygiene and infection control and prevention, coupled with suitable supporting engineering and administrative controls, is to be made a standard way of life in such facilities.

Hospitalized companion animals have increased susceptibility for hospital-acquired/nosocomial infections. Veterinarians have a responsibility to ensure adequate infection control, biosecurity, and biosafety within veterinary hospitals. Through elimination of pathogens and substitution of hazards, as well as implementation of engineering and administrative controls and the use of personal protective equipment, veterinary teams can dramatically reduce unintentional disease transmission.

Perioperative personnel are at risk for sharps injuries when using devices with sharp points and edges and therefore are at risk for infection from exposure to blood and other potentially infectious body fluids. The Occupational Safety and Health Administration bloodborne pathogens standard is the regulatory document that health care employers must follow to protect personnel who are at risk for sharps injuries. The AORN "Guideline for sharps safety" provides guidance to perioperative personnel for identifying sharps hazards and implementing best practices to prevent injuries. This article discusses the guideline recommendations for developing and implementing work practice controls and administrative controls for handling sharps. A scenario describes an interdisciplinary team's efforts to decrease specific sharps injuries and develop policies and procedures based on the identified risks and practice changes. Perioperative RNs should review the entire guideline for additional information when creating and updating policies and procedures for sharps safety.

A newly emerged respiratory viral disease called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is also known as pandemic coronavirus disease (COVID-19). This pandemic has resulted an unprecedented global health crisis and devastating impact on several sectors of human lives and economies. Fortunately, the average case fatality ratio for SARS-CoV-2 is below 2%, much lower than that estimated for MERS (34%) and SARS (11%). However, COVID-19 has a much higher transmissibility rate, as evident from the constant increase in the count of infections worldwide. This article explores the reasons behind how COVID-19 was able to cause a global pandemic crisis. The current outbreak scenario and causes of rapid global spread are examined using recent developments in the literature, epidemiological features relevant to public health awareness, and critical perspective of risk assessment and mitigation strategies. Effective pandemic risk mitigation measures have been established and amended against COVID-19 diseases, but there is still much scope for upgrading execution and coordination among authorities in terms of organizational leadership’s commitment and diverse range of safety measures, including administrative control measures, engineering control measures, and personal protective equipment (PPE). The significance of containment interventions against the COVID-19 pandemic is now well established; however, there is a need for its effective execution across the globe, and for the improvement of the performance of risk mitigation practices and suppression of future pandemic crises.

Objective: To assess the common respiratory disorders and estimate long term exposure of agricultural workers based on јob exposure matrices (JEMs). Methods: Our study evaluated the impact of occupational exposure on asthma and COPD development among 87 crop and 83 dairy farmers, compared to 80 administrative controls. Evaluation of subjects included standard questionnaire on chronic respiratory symptoms, spirometry testing, and assessment of occupational exposure by JEMs. Results: Asthma was registered in 8% of crop and 7.2% of dairy farmers, and in 5% of controls, whereas the prevalence of allergic was significantly higher compared to non-allergic asthma in exposed and unexposed workers. Occupational allergic asthma was registered in 2.3% of crop farmers and 1.2% of dairy farmers, while the frequency of work-aggravated asthma was 5.7% and 6.1% respectively. The COPD prevalence was non-significantly higher in exposed (6.9% in crop farmers and 8.4% in dairy farmers) compared to controls (3.8%). COPD was significantly associated with age over 40 years, smoking habit, and exposure duration. According to JEMs, asthma and COPD in crop farmers were significantly related to high intensity of exposure to dust, gases, fumes and vapors on a regular basis, while among dairy farmers they were significantly related to high intensity of dust exposure on a regular basis, as well as high intensity of exposure to gases, fumes and vapors both on sporadic and regular basis. Conclusion: Occupational exposure to respiratory hazards in agriculture may cause a variety of adverse respiratory health effects, being closely related to its duration, characteristics, and intensity, while JEMs are promising for farming settings.

The electrical safety community has made great strides in reducing electrical injuries to electrical workers through elimination, mitigation, administrative controls, worker training, and personal protective equipment. However, a large percentage of fatal and nonfatal electrical injuries occur to nonelectrical workers. This article uses Bureau of Labor Statistics data and Occupational Safety and Health Administration records to identify workers and types of work vulnerable to electrical injury. Odds of electrical or occupational injury or fatality are included for risk perspective. To decrease the likelihood of electrical injuries in at-risk workers, electrical safety programs must effectively target and reach at-risk workers. Appropriate training and ways to reach nonelectrical workers vulnerable to electrical injury are discussed.

BACKGROUND: Exposure to the coronavirus (COVID-19) in industrial workplaces has caused concerns all over the world. Implementation of prevention measures is the best solution for protection of workers’ health. OBJECTIVE: The present study investigated prevention measures and risk factors for the COVID-19 infection in Iranian small, medium, and large industries. METHODS: This study was conducted on 349 occupational health, safety, and environment professionals working in different industries. Data was collected using a checklist of prevention measures for COVID-19 and a questionnaire of risk factors for the infection. RESULTS: The results demonstrated that 32.60% of industries reported positive cases of COVID-19. The mean of prevention measures in all the dimensions, except use of personal protective equipment (PPE), was in favorable status. Among prevention measures against COVID-19, the dimensions of education, engineering controls, use of PPE, use of hand washing soap and disinfectant, and physical distance were not significantly different among small, medium, and large industries. However, administrative controls were statistically lower in small and medium industries compared to the large industries. Moreover, screening was statistically lower in small industries than in large industries. The mean risk factors of ventilation, use of common tools and equipment, and physical distance as well as total risk factors were not statistically different among different industries. CONCLUSION: Workers are at risk of COVID-19 infection. The risk factors of ventilation, sharing tools and equipment, and physical distance are critical in classification of risk of infection with COVID-19 in industrial settings.

Submitted by Ana Moreira (anadsmoreira@ufp.pt) on 2021-06-16T08:37:36Z No. of bitstreams: 1 DM_37711.pdf: 2310936 bytes, checksum: 32b274c9e416990fb8155b42d3b90715 (MD5) Approved for entry into archive by azevedo@ufp.pt (azevedo@ufp.pt) on 2021-06-16T10:19:15Z (GMT) No. of bitstreams: 1 DM_37711.pdf: 2310936 bytes, checksum: 32b274c9e416990fb8155b42d3b90715 (MD5) Made available in DSpace on 2021-06-16T10:19:16Z (GMT). No. of bitstreams: 1 DM_37711.pdf: 2310936 bytes, checksum: 32b274c9e416990fb8155b42d3b90715 (MD5) Previous issue date: 2021-06-04

Material-cart handling can be strenuous and lead to overexertion injuries. The aim of this study is to produce a thorough understanding of how the cart condition, tire type, physical environment-related factors, and load interact to influence the ergonomics and productivity of cart handling. Eighteen roofing carts with different conditions, tires, and loads were tested by one subject on three laboratory tracks: one L-shaped, one with ramps within constrained spaces, and one with obstacles within constrained spaces. A multiple linear regression analysis was performed to quantify the main and interaction effects of the factors of interest on the cart operations. The research findings confirm that using aged carts increases the injury risk by as much as 30.5% and decreases productivity by 35.4%. Our study also highlights the necessity of keeping an open space for cart operation, the travel distance from a cart to a ramp/obstacle should be greater than 61 cm. Finally, the results suggest the at-risk thresholds for different ramp slopes and obstacle heights, and the safe load capacities for the various working circumstances that are common on construction sites. The evidence created in this study can be translated into administrative controls for cart handling to reduce overexertion injuries and enhance performance.

Objectives This report shows the relationship between toner exposure and respiratory effects for individuals with a longterm occupational toner-handling history, from 2004 to 2013. Material and Methods Authors studied 752 Japanese male workers in toner handling workshops. A total of 673 men who participated in an annual monitoring survey were analyzed in this study. The following monitoring was performed in the same season each year: personal exposure measurements, biological markers, respiratory function tests, a chest X-ray, chronic respiratory symptoms and incidences of respiratory diseases. To evaluate the toner exposure effect, the exposure categories suitable for each evaluation index were established. Results For those with an occupational toner-handling history, the mean occupational toner-handling period was 14.36 years (standard deviation = 6.62); one participant had 35 years of exposure, which was the longest and one participant had 1 year of exposure which was the shortest. There were no statistically significant differences in the rate of change of respiratory function tests. An ANOVA conducted on blood and urine test results showed that statistically significantly differences were observed for a few items but all the values were very low and within the standard range. Conclusions Authors conducted a 10-year ongoing study, but no obvious negative influences on health were attributed to toner exposure. In a work environment where adequate administrative controls are in place, personal toner exposure levels may be expected to be low, with no adverse effects on human health. Int J Occup Med Environ Health 2018;31(6):809–822

The study explores how top management teams’ shared leadership is related to organizational ambidexterity in public-sector organizations, theoretically and empirically considering how this relationship is contingent on the management control system. Using a sample of 85 Swedish municipal housing corporations, we find that shared leadership has a positive relationship with organizational ambidexterity in public-sector organizations. Moreover, increasing use of new public management control systems, based on combined reward and performance controls, positively moderates this relationship. The study also finds that traditional public management control systems, based on combined planning and administrative controls, do not moderate the relationship between top management teams’ shared leadership and organizational ambidexterity. Accordingly, this article contributes to the public and strategic management literature, as well as to managerial practice. Points for practitioners The article suggests that sharing leadership within top management teams can result in a balanced resource allocation in municipal corporations. To be more effective in achieving this balance, public sector managers might consider emphasizing new public management-inspired management control systems and de-emphasizing those of a more traditional type.

Purpose This paper aims to explore and explain how administrative controls have been changed as a response to a significant crisis, using the transition of the three largest Icelandic banks from bankrupt to operational entities after the 2008 financial crisis. The Icelandic banks are compared with three Danish banks to separate crisis-driven responses from simple market-driven reactions. Design/methodology/approach Empirical data were collected using semi-structured interviews. The participating Icelandic and Danish banks were considered as two units, which formed the basis for a comparative case study between the two countries. Findings Driven by an understanding of what is expected by the market rather than the need to inform and guide the employees the Icelandic banks implemented a number of revolutionary and formally documented changes. These changes included significant bigger risk management functions and policies and procedures documenting “everything”. However, in both countries, it seems that new values supported by the “tone at the top”, areas with limited formal documentation, are the most important management tools. Research limitations/implications The study relies on interviews with employees, and the actual changes of administrative controls have not been reviewed. The most important implication is that the situated logics in Iceland driven by external institutional pressure initiated a revolutionary implementation of values bypassing existing routines and formalised rules. Originality/value Although the use of management controls has been studied intensively, detailed studies of the banking sector have been lacking. Furthermore, there is limited knowledge of how administrative controls changed in response to the financial crisis.

The past two decades have seen a rise in university laboratory accidents in China. Although there is a growing awareness due to higher reporting and media coverage, the evaluation and understanding of common hazards and deficiencies in university laboratories remains to be addressed. Aiming to enhance safety in laboratory-related activities, this study analyzed the current status and challenges of university laboratory safety in China and presented future directions to reduce accidents using engineering and administrative controls. A descriptive statistical analysis of 110 publicly reported university laboratory accidents in mainland China since 2000 was performed to investigate the proximate causes of the accidents, and further, to identify potential deficiencies existing in the current safety management of laboratories. It was found that human factors were the most contributing cause and the training element was a vulnerable competency in laboratory safety management. Based on the results, a comparative analysis between the underlying reasons for the poor safety situation and the efforts that have been made has brought the challenges and possible solutions for safety improvements in university laboratories. By suggesting top-down and bottom-up approaches, the present study provides valuable insights and serves as a reference for universities and relevant authorities to enhance safety in university laboratories.

This paper analyses the major noise producing machines, the effects of the noise, its control methods and the extent of the utilisation of these methods by the Nigerian manufacturing companies. Nine companies were chosen as models to represent the overall manufacturing sectors in Nigeria. The noise produced by the various machines and equipment used in the production processes in the companies was analysed. Results obtained showed that electricity generating sets produced the highest noise, followed by air compressor, boiler, pressing machine and other machines put together, in that order. The results also revealed that more than half of the total effects of noise are on workers. The effects of noise on workers are more of physiological than psychological. It is recommended that engineering controls combined with administrative controls should be considered as the methods that will provide thorough and permanent solution to the noise problem in the manufacturing companies.

About 12 million workers are involved in the production of basic grains in Central America. However, few studies in the region have examined the occupational factors associated with inhalable dust exposure. About the objectives: (i) To assess the exposure to inhalable dust in workers from rice, maize, and wheat storage facilities in Costa Rica; (ii) to examine the occupational factors associated with this exposure; and (iii) to measure concentrations of respirable and thoracic particles in different areas of the storage facilities. As for the methods, we measured inhalable (

Infections among health-care personnel (HCP) occur as a result of providing care to patients with infectious diseases, but surveillance is limited to a few diseases. The objective of this study is to determine the annual number of influenza infections acquired by HCP as a result of occupational exposures to influenza patients in hospitals and emergency departments (EDs) in the United States. A risk analysis approach was taken. A compartmental model was used to estimate the influenza dose received in a single exposure, and a dose-response function applied to calculate the probability of infection. A three-step algorithm tabulated the total number of influenza infections based on: the total number of occupational exposures (tabulated in previous work), the total number of HCP with occupational exposures, and the probability of infection in an occupational exposure. Estimated influenza infections were highly dependent upon the dose-response function. Given current compliance with infection control precautions, we estimated 151,300 and 34,150 influenza infections annually with two dose-response functions (annual incidence proportions of 9.3% and 2.1%, respectively). Greater reductions in infectious were achieved by full compliance with vaccination and IC precautions than with patient isolation. The burden of occupationally-acquired influenza among HCP in hospitals and EDs in the United States is not trivial, and can be reduced through improved compliance with vaccination and preventive measures, including engineering and administrative controls.

As a toxic waste stream, E-waste poses serious challenges to the waste management initiatives in India. While the hazardous components of E-waste call for environment-friendly disposal mechanisms, the valuable and precious metal constituents necessitate adequate infrastructural provisions and responsible management programmes to avoid the loss of economically vital materials. Considering this duality, this paper is an attempt to evaluate the current E-waste disposal practices in India, particularly emphasizing on the city of Bangalore. Three sectors listed as ‘bulk consumers’ of electrical and electronic equipments under the recent E-waste (Management) Rules, 2016, namely (1) IT and electronics, (2) banking and (3) education, are considered for the study purpose. Our experience suggests that these bulk consumers adopt two different approaches to comply with the new EPR guidelines as enlisted in the E-waste (Management) Rules, 2016. These are: (1) IT companies like Wipro adopts a ‘take-back system’ where it is responsible for taking back the products originally produced in its various facilities from the consumers; (2) most of the banks and educational institutes take ‘auction’ as the measure by calling tenders from authorized E-waste recyclers with some banks embracing an ‘E-waste exchange system’, or complying through producer responsibility organizations (PROs) for responsible E-waste management in the city. However, we sense a lack of meticulous initiatives towards addressing the E-waste crisis largely prevalent across these sectors. We argue that ensuring responsible disposal behaviour is central in any successful E-waste management initiative. Further, we emphasize on the relative disinterestedness of the research community in addressing the issues concerning E-waste in India by carrying out a detailed bibliometric analysis on the topic. We conclude that a transparent system across these diverse sectors with adequate infrastructural provisions and administrative controls is the key to address India’s E-waste apprehensions.

As one of the most important energy resources in the world, coal contributes a great deal to the world economy. Coal mining and processing involve multiple dust generation processes including coal cutting, transport, crushing and milling etc. Coal dust is one of the main sources of health hazard for the coal workers. Exposure of coal dusts can be prevented through administrative controls and engineering controls. Ineffective control of coal dust exposure can harm coal workers' health. Although many efforts have been made to eliminate these threats, recent years have seen an unexpected increase in coal workers' pneumoconiosis (CWP) in Appalachian basin in US. To explore the reasons for this phenomenon, in this review, we first reviewed the historical studies on coal mine dust including the regulation and engineering controls. Then, the effects of coal dust on human health was comprehensively reviewed. Next, the effects of nanoparticles on human health were reviewed, with an emphasis on toxicity of nanoparticles such as carbon nanotubes in other industries. From all this information, we hypothesize that nano-sized coal dust has contributed to the increase of CWP prevalence in recent years. As no research has been reported in this area, four directions which may need further investigation and future studies are recommended in this review. They include: 1) Systematic characterization of physicochemical properties of nano-size coal dust; 2) Toxicity and pathogenesis of nano-sized coal dust; 3) Development of real-time monitoring technology and equipment for nano-sized coal dust; 4) Development of exposure control technology and equipment. The intent of this review paper is to demonstrate the variation of coal dust properties and their impact on the mine worker's health. We suggest that the impact of nano-sized coal mine dust on miner's health has not yet been understood well and further improvements are necessary.

Background: Hand hygiene (HH) is the single most important means of preventing hospital-acquired infections. We set out to determine the knowledge, training gaps, and practice of HH in a tertiary health institution in a resource constrained setting. Methods: This cross-sectional study was conducted among health care workers in a 600-bed capacity tertiary health centre. The study was conducted between April and November 2013. A multi-stage randomized sampling method was used to self-administer 322 WHO HH knowledge questionnaires. Information on HH training in the past 3 years, knowledge and practice of HH were obtained, and data were analysed using Epi-Info version 3.5.1. Results: A response rate of 98.5% was obtained for the HH knowledge assessment. Mean age of the study population was 39 ± 9.8. About 64% were females. Of all the respondents, only 16% had good knowledge of HH, 52% had moderate knowledge while 32% had poor knowledge. About 24% had formal training on HH. In terms of practice, only about 22% of the respondents self-reported routine practice of HH. Conclusions: The findings in this study suggest that there is sub-optimal HH knowledge, practice and training. It is imperative to improve the HH training and retraining of health care workers with a focus on attendants. Administrative controls and bold signage in healthcare institutions are also recommended.

A power supply failure caused a loss of power to key ventilation systems in an operating nuclear facility. The in-cell depression was lost, which led to an egress of activity through prepared areas and into the normal operating areas. After an initial programme of radiological monitoring to quantify and categorise the activity in the operating areas, a plan was developed for the decontamination and remediation of the plant. The scope of the recovery plan was substantial and featured several key stages. The contamination was almost entirely 137Cs, reflecting the α:β/γ ratio for the facility. In addition to the physical remediation work, several administrative controls were introduced such as new local rules, safety signage to indicate abnormal radiological conditions in certain areas and training of the decontamination teams. All areas of plant, which were contaminated, were returned to normal access arrangements and the plant was successfully returned to full operational capability

We analyse the patterns of multi‐bi aid in the European Union. Using newly available multi‐bi aid data and a large number of staff interviews at the European Commission, the World Bank and bilateral donors, we draw three conclusions. First, the Commission's capacity constraints and lack of specific expertise have prevented it from becoming an important host of trust funds like other international development organizations. Second, the same capacity constraints can generally explain its extensive participation in trust funds at other international development organizations. In the case of large global funds, however, Commission participation often reflects the outcome of member state politics. Third, once the Commission delegates its aid to multilateral agencies, it does not impose strong substantive earmarking, but requires a high level of legal and administrative controls.

This study is to identify the critical risk in cleaning process at the laundry area by using Semi-Quantitative Risk Assessment Matrix. In the identification of hazard, observation at the workplace, semi-structure interviewed with four workers who are an expert in the respective area and reviewed for publication report from authorities’ bodies used as an input in risk assessment. The possibility of fingers caught into the flatwork iron (risk value: 9) has been identified the most critical risk. The appropriate risk control was isolation, engineering controls, administrative controls and personal protective equipment. This study may help employer be more proactive in ensuring the safety and health of workers.

This article examines the pathways – citizen-driven, bottom-up oversight or state-centred administrative controls – that have played the largest role in promoting the accountability of the Bolsa Fa...

Germany implemented a new occupational disease “squamous cell carcinoma or multiple actinic keratosis due to natural UV radiation (UVR)” into the German ordinance on occupational diseases. Since primary prevention is very important, the aim of this study was to assess the provision of sun protection measures by the employers in vocational school students for outdoor professions. We conducted a cross-sectional study on the availability of sun protection measures at German workplaces and the risk of occupational sunburn by surveying 245 vocational school students working in outdoor occupations. More than 40 % of the students did not receive any sun protection measures by their employer, and 34.5 % of the students got sunburned during work. Working in the shade was a protective factor for occupational sunburn but was merely available for 23.7 % of the outdoor workers. Our study reveals a strong need for effective sun protection measures, including both administrative controls like education and personal protection measures at German outdoor workplaces.