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Objective: Sufficient sleep is essential for well-being. We examined the relationship between work-related social support, work stress, and sleep sufficiency, predicting that workers with higher social support would report higher sleep sufficiency across varying levels of work stress., Methods: The data set analyzed in the present study included 2213 workers from approximately 200 small (<500 employees) businesses in high, medium, and low hazard industries across Colorado., Results: Perceived social support variables moderated the relationship between work stress and sleep sufficiency such that employees reporting higher levels of social support reported higher sleep sufficiency when work stress was low or moderate but not high., Conclusions: Although preventing work stress is optimal, in cases where employers cannot apply primary interventions to prevent stress (eg, eliminating/reducing night shifts), employers should attempt to increase social support or other more relevant resources for employees., Competing Interests: Conflicts of interest: None declared., (Copyright © 2023 American College of Occupational and Environmental Medicine.)

We analysed the long-term outcomes of patients with primary optic nerve sheath meningioma (ONSM) treated with stereotactic radiotherapy (SRT). 26 patients with primary ONSM were treated with SRT between 2004 and 2013 at a single institution. SRT was delivered with image guidance to a median dose of 50.4 Gy in 28 fractions. 4 patients had prior surgical debulking. At a median radiological follow-up of 68 months, the MRI based tumour control was 100%. Visual acuity improved in 10 (38.4%), remained stable in 10 (38.4%) and was reduced in 6 (23.1%) patients following treatment. Stable or improved vision post-treatment was seen in 92.3% of patients with good pre-treatment vision (best corrected visual acuity 6/18 or better), compared to only 61.5% of patients with poor pre-treatment vision (best corrected visual acuity 6/24 or worse). Overall, the treatment was well tolerated with no Grade 2 or greater acute toxicity. Minimal other ophthalmic complications were seen with only one patient developing late onset Grade 3 radiation retinopathy., (Copyright © 2019. Published by Elsevier Ltd.)

Purpose: The objective of this study was to investigate the efficacy and safety of fractionated stereotactic radiotherapy in the treatment of cavernous venous malformation of the orbital apex., Methods: The authors reviewed a prospective database from a single center of patients with cavernous venous malformation of the orbital apex who had treatment with fractionated stereotactic radiotherapy. The authors compared the symptoms, visual function and the size of the tumor pre- and posttreatment as well as reviewed the treatment details and the incidence of complications., Results: Six patients received treatment with fractionated stereotactic radiotherapy for cavernous venous malformation involving the orbital apex. The median age was 48 (range, 32-63), and 50% were female. Patients received a dose of 45 to 50.4 Gy in 1.8 to 2 Gy fractions. Median follow up was 33 months (range, 18-66 months). The average tumor volume reduction at posttreatment imaging after 12 months was 63%. All lesions reduced in size postradiotherapy and remained controlled for the duration of follow up. All patients who had proptosis or a visual field defect had an improvement in the symptoms posttreatment. There were no complications of the treatment., Conclusion: Fractionated stereotactic radiotherapy appears to be a safe and effective management option for cavernous venous malformation of the orbital apex and leads to a sustained reduction of the volume of the lesion with associated improvement in symptoms and visual function.

Objective: Worksite wellness programs (WWP) may positively impact employee health, medical expenditures, absenteeism, and presenteeism. However, there has been little research to assess the benefits of WWP in small businesses. The purpose of this study is to prospectively evaluate changes in health, absenteeism, and presenteeism for employees who participated in a WWP., Methods: We conducted an observational, 3-year cohort study of 5766 employees from 314 businesses of differing sizes. We followed two cohorts of employees, who completed at least two annual health risk assessments (HRA) between May 2010 and December 2014. Changes from baseline to the first and second follow-up periods were assessed for chronic and non-chronic health conditions, absenteeism, and presenteeism., Results: Small business employees were more likely to participate in the WWP than were employees from large businesses. Changes in chronic and non-chronic health conditions varied by size of business, with small business employees showing improvements in stress, overall health, depression, smoking status, vegetable and fruit consumption, and physical activity, and in their perceptions of job health culture. In contrast, large business employees experienced improvements in stress, vegetable consumption, and alcohol use. No changes in absenteeism or presenteeism were observed., Conclusions: Small businesses achieve higher employee participation rates and more health improvements when compared to employees from large employers. Findings suggest that small businesses may gain the most from a WWP.

Objective: The aim of this study was o examine how work and nonwork health-related factors contribute to workers' compensation (WC) claims by gender., Methods: Workers (N = 16,926) were enrolled in the Pinnacol Assurance Health Risk Management study, a multiyear, longitudinal research program assessing small and medium-sized enterprises in Colorado. Hypotheses were tested using gender-stratified logistic regression models., Results: For both women and men, having incurred a prior WC claim increased the odds of a future claim. The combination of incurring a prior claim and having metabolic health conditions resulted in lower odds of a future claim. Behavioral health risk factors increased the odds of having a claim more so among women than among men., Conclusion: This study provides data to support multifactorial injury theories, and the need for injury prevention efforts that consider workplace conditions as well as worker health.

Nearly half of Americans are employed by small businesses, and future projections suggest that the number of those employed by small businesses will rise. Despite this, there is relatively little small business intervention research on the integration of health protection and health promotion, known as Total Worker Health® (TWH). We first discuss the importance of studying small businesses in TWH research and practice. Second, we describe an example of a small business TWH intervention, Health Links™ plus TWH owner/senior manager leadership training, that we are evaluating via the Small+Safe+Well (SSWell) study. Key features of the intervention and the SSWell study include attention to multi-level influences on worker health, safety and well-being; organizational change; and dissemination and implementation science strategies via the RE-AIM model. We offer several considerations for future small business TWH research and practice both in terms of the small business context as well as intervention development and evaluation. Our goal is to provide TWH researchers and practitioners with a framework and an example of how to approach small business TWH interventions. Ultimately, through the SSWell study, we aim to provide small businesses with strong evidence to support the use of TWH strategies that are practical, effective and sustainable., Competing Interests: Conflict of Interest Statement: On behalf of all authors, the corresponding author states that there is no conflict of interest.

Objective: The objective of this study was to examine the predictive relationships between employee health risk factors (HRFs) and workers' compensation (WC) claim occurrence and costs., Methods: Logistic regression and generalised linear models were used to estimate the predictive association between HRFs and claim occurrence and cost among a cohort of 16 926 employees from 314 large, medium and small businesses across multiple industries. First, unadjusted (HRFs only) models were estimated, and second, adjusted (HRFs plus demographic and work organisation variables) were estimated., Results: Unadjusted models demonstrated that several HRFs were predictive of WC claim occurrence and cost. After adjusting for demographic and work organisation differences between employees, many of the relationships previously established did not achieve statistical significance. Stress was the only HRF to display a consistent relationship with claim occurrence, though the type of stress mattered. Stress at work was marginally predictive of a higher odds of incurring a WC claim (p<0.10). Stress at home and stress over finances were predictive of higher and lower costs of claims, respectively (p<0.05)., Conclusions: The unadjusted model results indicate that HRFs are predictive of future WC claims. However, the disparate findings between unadjusted and adjusted models indicate that future research is needed to examine the multilevel relationship between employee demographics, organisational factors, HRFs and WC claims., Competing Interests: All coauthors have filled out the ICMJE form. The competing interests include support from Pinnacol Assurance to conduct this study., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objectives/hypothesis: To determine whether there is an association between the geographic location of an applicant's undergraduate school, medical school, and residency program among matched otolaryngology residency applicants., Study Design: Observational., Methods: Otolaryngology residency program applications to our institution from 2009 to 2013 were analyzed. The geographic location of each applicant's undergraduate education and medical education were collected. Online public records were queried to determine the residency program location of matched applicants. Applicants who did not match or who attended medical school outside the United States were excluded. Metro area, state, and region were determined according to US Census Bureau definitions., Results: From 2009 to 2013, 1,089 (78%) of 1,405 applicants who matched into otolaryngology residency applied to our institution. The number of subjects who attended medical school and residency in the same geographic region was 241 (22%) for metropolitan area, 305 (28%) for state, and 436 (40%) for region. There was no difference in geographic location retention by gender or couples match status of the subject. United States Medical Licensing Exam step 1 scores correlated with an increased likelihood of subjects staying within the same geographic region (P = .03)., Conclusions: Most otolaryngology applicants leave their previous geographic area to attend residency. Based on these data, the authors recommend against giving weight to geography as a factor when inviting applicants to interview., Level of Evidence: NA., (© 2015 The American Laryngological, Rhinological and Otological Society, Inc.)

Purpose: To compare the survival impact of adjuvant external beam radiation therapy (RT) for malignant gliomas of glioblastoma (GBM), anaplastic astrocytoma (AA), anaplastic oligodendroglioma (AO), and mixed anaplastic oligoastrocytoma (AOA) histology., Methods and Materials: The Surveillance, Epidemiology, and End Results (SEER) database was queried from 1998 to 2007 for patients aged ≥18 years with high-grade gliomas managed with upfront surgical resection, treated with and without adjuvant RT., Results: The primary analysis totaled 14,461 patients, with 12,115 cases of GBM (83.8%), 1312 AA (9.1%), 718 AO (4.9%), and 316 AOA (2.2%). On univariate analyses, adjuvant RT was associated with significantly improved overall survival (OS) for GBMs (2-year OS, 17% vs 7%, p<.001), AAs (5-year OS, 38% vs 24%, p<.001), and AOAs (5-year OS, 55% vs 44%, p=.026). No significant differences in OS were observed for AOs (5-year OS, with RT 50% vs 56% without RT, p=.277). In multivariate Cox proportional hazards models accounting for extent of resection, age, sex, race, year, marital status, and tumor registry, RT was associated with significantly improved OS for both GBMs (HR, 0.52; 95% CI, 0.50-0.55; P<.001) and AAs (HR, 0.57; 95% CI, 0.48-0.68; P<.001) but only a trend toward improved OS for AOAs (HR, 0.70; 95% CI, 0.45-1.09; P=.110). Due to the observation of nonproportional hazards, Cox regressions were not performed for AOs. A significant interaction was observed between the survival impact of RT and histology overall (interaction P<.001) and in a model limited to the anaplastic (WHO grade 3) histologies. (interaction P=.024), characterizing histology as a significant predictive factor for the impact of RT. Subgroup analyses demonstrated greater hazard reductions with RT among patients older than median age for both GBMs and AAs (all interaction P≤.001). No significant interactions were observed between RT and extent of resection. Identical patterns of significance were observed for cause-specific survival and OS across analyses., Conclusions: In this large population-based cohort, glioma histology represented a significant predictor for the survival impact of RT. Adjuvant RT was associated with improved survival for AAs, with benefits comparable to those observed for GBMs over the same 10-year interval. No survival advantage was observed with adjuvant RT for AOs., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Introduction: The main purpose of this study was to investigate the psychological and functional impact attributed to acoustic neuroma symptoms., Materials and Methods: A sample of 207 acoustic neuroma patients completed a study-specific questionnaire about the severity, frequency, and psychological and functional impact of 9 acoustic neuroma symptoms., Results: The survey response rate was 56.4 per cent. All symptoms had some degree of psychological impact for the majority of participants; hearing loss was the symptom most often reported to have a severe psychological impact. The majority of respondents reported functional impact attributed to hearing loss, balance disturbance, dizziness, eye problems, headache and fatigue; balance disturbance was the symptom most often reported to have a severe functional impact. For most symptoms, psychological and functional impact were related to severity and frequency., Conclusion: Of the acoustic neuroma symptoms investigated, hearing loss and balance disturbance were the most likely to have a severe psychological and functional impact, respectively.

Metastases to the brain and spine are common and difficult to treat. Stereotactic radiosurgery (SRS) is a non-invasive treatment option for some individuals, and may obviate the need for open surgery and/or whole brain radiotherapy. Over the past decade there has been an increased number of patients undergoing SRS for the treatment of metastatic disease, and multiple published studies show favourable results in terms of local disease control. We review the available literature pertaining to the application of SRS for the treatment of brain and spine metastases, together with its limitations and outcomes., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

The objectives of this study were to describe anxiety and depression levels among acoustic neuroma patients; examine differences in anxiety and depression across the acoustic neuroma management options of microsurgery, radiation and observation; and to investigate management, medical and demographic factors that might predict anxiety and depression in this patient group. A cross-sectional questionnaire was completed by 205 adults diagnosed with, or treated for, a unilateral acoustic neuroma within five years of questionnaire distribution. Median age of participants was 57.0 years, and 120 (58.5%) were female. Anxiety and depression were measured using the Hospital Anxiety and Depression Scale (HADS). Clinically significant anxiety was reported by 29.8% of participants and 10.2% were depressed. Mean anxiety and depression scores did not differ from general population norms. No significant differences in anxiety and depression were found across management options. Time since management, number of symptoms and comorbid medical conditions predicted anxiety, while depression was predicted by number of symptoms. This appears to be the first study among acoustic neuroma patients in which anxiety and depression were compared across management options. Treating physicians should be aware that as the number of acoustic neuroma symptoms increases, so may the likelihood of clinically significant anxiety and depression., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Purpose: To assess factors related to the risk of acute urinary retention and other morbidity indices in patients undergoing transperineal seed implantation of the prostate., Materials and Methods: One hundred and seventy-three consecutive patients treated with (125)Iodine transperineal interstitial permanent prostate brachytherapy (TIPPB) were evaluated. Various demographic, pathological, symptomatic, urodynamic and dosimetric values were assessed in relation to the incidence of acute urinary retention as well as the International Prostate Symptom Score (IPSS) dynamics. Patients were routinely placed on alpha-blockade postimplant. Dosimetry was based on CT scan one month postimplant., Results: Acute urinary retention developed in thirty-four patients (19.7%), at a median time of four days. Peak urinary flow rate was the only independent factor which varied significantly between those suffering retention and those not (median of 16 and 19.5 ml/s respectively, P=0.005). Median preimplant IPSS was 4.0, with a median peak of 16 at 3 months. Actuarial median time to return to baseline IPSS was at 15 months. The peak IPSS above preimplant levels was correlated significantly in multivariate analysis with the number of seeds implanted superior to the physician-nominated anatomical base level of the prostate (P<0.009), as well as lower preimplant IPSS values., Conclusions: In our series, preimplant urinary flow rate was the most important factor predictive of postimplant acute urinary retention. The patients' risk of having heightened IPSS change following implantation was correlated to a lower preimplant IPSS and an increased number of seeds implanted above the level of the prostatic base, possibly reflecting bladder base rather than urethral irritation in the development of acute urinary morbidity.

Purpose: To assess the efficacy of a variety of prognostic models in the definition of intermediate-risk prostate cancer and to compare them to our own empiric model., Methods and Materials: Two hundred fifty-six consecutive men with prostate adenocarcinoma treated with external beam radiotherapy alone were studied. Biochemical failure (defined as 3 consecutive PSA rises or the initiation of androgen deprivation therapy) was examined using univariate, multivariate, and recursive partitioning analyses. The risk classification model used in our department was then compared to a number of published models to assess the relative performance of each in discriminating risk groups., Results: At a median follow-up of 62.4 months, the 5-year Biochemical failure-free survival (bFFS) was 46.8% for the overall group. This relates to 5-year bFFS of 77.8%, 51.1%, and 33.8% based on our institutional criteria for low-, intermediate-, and high-risk features, respectively. All the models examined showed an outcome group with a comparatively similar poor outcome when applied to our data. Large variation was seen in the intermediate-risk groups, with 5-year bFFS ranging from 38.1% to 51.1%. Good risk categories had similar large variations. All published models showed inability to delineate three significantly different outcome groups. Recursive partitioning analysis derived categories based on combinations of PSA (with cutpoints at 42.4, 20, and 10.6 ng/mL) and Gleason score (with cutpoints at 2-6 and 7-10) only., Conclusions: Large variations in the relative performance of a number of prognostic models are shown when applied to our local data. The prognostic efficacy of PSA and biopsy Gleason score is reiterated, although other factors will need to be explored to further improve the performance of prognostic models, particularly in defining the intermediate-risk subset of prostate cancer.

Purpose: At the William Buckland Radiotherapy Center (WBRC), field-only electronic portal image (EPI) hard copies are used for radiation treatment field verification for whole brain, breast, chest, spine, and large pelvic fields, as determined by a previous study. A subsequent research project, addressing the quality of double exposed EPI hard copies for sites where field only EPI was not considered adequate to determine field placement, has been undertaken. The double exposed EPI hard copies were compared to conventional double exposed port films for small pelvic, partial brain, and head and neck fields and for a miscellaneous group., Methods and Materials: All double exposed EPIs were captured during routine clinical procedures using liquid ion chamber cassettes. EPI hard copies were generated using a Visiplex multi-format camera. In sites where port film remained the preferred verification format, the port films were generated as per department protocol. In addition EPIs were collected specifically for this project. Four radiation oncologists performed the evaluation of EPI and port film images independently with a questionnaire completed at each stage of the evaluation process to assess the following: Adequacy of information in the image to assess field placement. Adequacy of information for determining field placement correction. Clinician's preferred choice of imaging for field placement assessment, Results: The results indicate that double exposed EPI hard copies generally do containsufficient information to permit evaluation of field placement and can replace conventionaldouble exposed port films in a significant number of sites. These include the following:pelvis fields < 12 X 12 cm, partial brain fields, and a miscellaneous group. However forradical head and neck fields, the preferred verification image format remained port film dueto the image hard copy size and improved contrast for this media. Thus in this departmenthard copy EPI is the preferred modality of field verification for all sites except radical headand neck treatments. This should result in an increase in efficiency of workloadmanagement and patient care.

Purpose: To discriminate between random and systematic treatment setup errors using portal films., Methods and Materials: A bi-dimensional analytic techniques using multiple analyses of variance based on Hotelling's T2 statistics to derive numerical and graphical measures of daily portal film accuracy and precision has been trialed using 88 daily portal films from seven patients' treatment., Results: A demonstration is provided of how a reasonable approximation of random variation from the intended (Simulator) field center, and systematic displacement of the mean position of the portal film centers may be derived from a minimum number of portal films. If a random error as great as 10 mm exists, at least six or seven portal films are considered necessary to reliably detect and quantify the size of a systematic error., Conclusion: Our results suggest that a modest systematic error could go undetected until the end of a 5 or 6 week course of treatment if only one portal film is obtained each week. A greater number of portal films should be performed during the first week of treatment to reduce the frequency of such errors. Efforts to separate and quantify both random and systematic errors in setup are worthwhile and will lead to improvements in outcome at the individual patient level and at a departmental level in the development of quality assurance programs.

Between 1981 and 1986, 89 patients with advanced head and neck squamous cancer were treated with a continuous accelerated fractionation radiotherapy (AFRT) regimen. Three fractions of 1.80 Gy, 4 h apart, were given on three treatment days per week (Monday, Wednesday, Friday), and the tumour dose was taken to 59.40 Gy in 33 fractions in 24-25 days. Acute mucosal reactions were generally quite severe, but a split was avoided by providing the patient with intensive support, often as an in-patient, until the reactions settled. Late radiation effects have been comparable to those obtained with conventional fractionation. The probability of local-regional control was 47% at 3 years for 69 previously untreated patients, whereas it was only 12% at one year for 20 patients treated for recurrence after radical surgery. Fifty-eight previously untreated patients with tumours arising in the upper aero-digestive tract were analysed in greater detail. The probability of local-regional control at 3 years was 78% for 17 Stage III patients and 15% for 31 Stage IV patients. This schedule of continuous AFRT is feasible and merits further investigation.