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Outcomes are events, occurrences, or conditions that indicate progress in achieving the purpose of the program. Outcomes can be viewed from two different perspectives-ultimate and intermediate. For an occupational safety and health research program like the NIOSH Work Organization and Stress-related Disorders Program, ultimate outcomes are reductions in a particular type of worker injury or illness, or a reduction in exposures that result in injury or illness. Injuries and illnesses have complex causes, and any effect of program activities on rates can take years to be seen. Therefore, outcomes are often measured on an intermediate timeframe. Intermediate outcomes are necessary steps that lead to ultimate outcomes, for example, development and implementation of guidelines that will lead to reductions in exposures and risk of injury or illness. For occupational safety and health research programs, achieving intermediate risk reductions is as important as achieving the ultimate outcome of decreasing injury and illness incidence rates.

Intermediate Outcomes

NIOSH works with Florida Department of Health to reduce safety and health risks in emergency responders

NIOSH is working with the Florida Department of Health to minimize the extreme stresses to which their workers are exposed during hurricane response and recovery, and to improve emergency response operations. Survey data from 5,000 emergency response workers are being used to identify and reduce organizational problems and other factors that create stress and obstruct emergency response operations during hurricanes. Fifteen thousand Florida emergency response workers stand to benefit from this effort, leading to improvements in the effectiveness of emergency response and well-being for virtually the entire population of Florida.

Improved rest break schedules developed by NIOSH implemented among office workers

An experimental rest break schedule developed by NIOSH was found to reduce musculoskeletal discomfort, fatigue, and eyestrain during evaluations at three Internal Revenue Service (IRS) Centers, and was subsequently implemented for 1,000 IRS data entry workers. Improved rest break schedules of this nature are now being heavily marketed for application in workplaces with computer-intensive tasks, and these interventions are expected to result in significant reductions in worker morbidity. This expectation is supported by the results of epidemiological research demonstrating that improved rest break schedules are significantly associated with long-term (2-year) reductions in medically-diagnosed musculoskeletal disorders.

NIOSH research to improve standards for limiting exposure to hand-transmitted vibration

In the United States, more than 1.5 million workers are exposed to hand-transmitted vibration through the use of powered and pneumatic hand tools. NIOSH has designed studies to directly assess how various characteristics of vibration exposure, the duration of exposure, and other work organization factors affect the risk of developing a vibration-induced injury. These data, along with the data from other labs are being used by the International Standards Organization (ISO), the American National Standards Institute (ANSI), and the European Union to revise dose-response relationships and establish daily limits on the amount of time that workers should be exposed to vibration. Workplaces use these standards to limit the exposures of the workers to vibration by setting up work rotation schedules or using devices to protect workers from the exposure.

NIOSH Web site widely used to improve methods in work organization research

NIOSH recently developed a searchable database of assessment methods for characterizing the organization of work to facilitate research on the associations between work organization and worker safety and health. The database presently maintains records for more than 40 assessment instruments containing more than 185 measures of work organization. Evidence suggests this resource is being used extensively by NIOSH stakeholders in academia to improve research on understanding and preventing workplace illness and injury related to work organization factors. In the first 6 months of operation, the Web site received more than 3,800 visitors who queried more than 1,500 topics.

NIOSH training exercise to improve work organization and reduce farm injury widely adopted by agricultural training programs

In collaboration with extramural partners, NIOSH has developed a computer-based training program that enables farmers and their families to better understand the close connection between farm workload demands and risks for injury and stress, and ways to reduce these risks. This participatory exercise ("The Kayles' Difficult Decisions") allows farm family members to see how easy it is to be caught up in the day-to-day requirements of keeping their farm running without realizing the degree to which family members are exposed to serious injury-including injuries that might cause the family to lose their farm. The exercise is being used widely to improve farm worker awareness of ways to reduce their risks of injury. Working with the Southeast Center for Agricultural Health and Injury Prevention, the University of Kentucky College of Agricultural Economics, the American Farm Bureau, and other groups, this simulation exercise is being delivered in county extension meetings, farm safety training groups, and college and high school classes; it has also been used to introduce a farm safety intervention to promote rollover protective structures on tractors.

NIOSH tools widely used to improve work organization research

NIOSH developed the Generic Job Stress Questionnaire (GJSQ) to provide NIOSH stakeholders in academia with a new tool for assessing work organization factors in studies on work organization and worker stress, safety, and health. The GJSQ measures a wide variety of work organization variables, including job control, job demands, social support, job security, work schedules, etc. The GJSQ has become a standard research tool and is used extensively in work organization research internationally to better understand the safety and health risks of work organization and ways to reduce these risks. It has been translated into Japanese, Korean, and Spanish.

NIOSH method to improve miner safety behaviors widely adopted for mine safety training

NIOSH pioneered a new training method to improve miners' decision-making skills in responding to mine emergencies (e.g., first aid, self-rescue, and escape), and to integrate safety concepts within the context and performance of routine mine work. The training exercises are based on events in actual mine accidents and emergencies and reflect the problems and predicaments encountered by miners in these real-life events. Each problem-solving story is presented in a booklet as an unfolding story, and trainees make a series of choices among good and bad action alternatives at critical decision points. Feedback is provided about the consequences of chosen actions. One hundred and forty-seven organizations purchased the exercises from the National Mine Health and Safety Academy over a 2-year period and were subsequently queried about the exercises. Sixty percent of the 52 respondents rated the exercises as more useful than traditional instructional materials, 40% as equally useful, and 0% as less useful. Ninety-four percent of the trainers judged the exercises as a good value; 92% planned to order more simulations in the future. /niosh/mining/pubs/pubreference/outputid48.htm

NIOSH increases professional capacity for research and practice to address work organization problems

In 1996 NIOSH entered into a cooperative agreement with the American Psychological Association to foster graduate training in safety, health, and the organization of work. By 2002, start-up funding had been provided to 11 universities for interdisciplinary graduate programs that blended training in psychology and occupational safety and health. Fifty-three graduate students completed this course of study within the timeframe of the cooperative agreement (1996-2002). By 2004, two universities (U. Connecticut; Portland State U.) had successfully competed for NIOSH training grants for sustained graduate training programs with this interdisciplinary focus. This effort has significantly increased the supply of researchers and practitioners with the capacity to address work organization problems in the workplace.

NIOSH-funded research instrumental in setting safe limits for medical resident working hours

Three studies conducted at Harvard University and co-funded by NIOSH examined the impact of long and extended work hours on medical interns' clinical performance and risk for car crashes. The findings were included in the rationale for standards setting by the Accreditation Council for Graduate Medical Education (ACGME), which instituted standards in 2003 that limit duty hours for resident physicians in all accredited programs. ACGME accredits more than 8,000 programs that provide for the education of 100,000 residents, and is the entity that enforces resident duty hour limits. Two years after the establishment of the ACGME duty hour standards, the vast majority of residency programs are complying with these standards according to a confidential internet survey

NIOSH report instrumental in standards to improve safety in commercial vehicle operation

The NIOSH publication Overtime and Extended Work Shifts: Recent Findings on Illnesses Injuries and Health Behaviors was influential in the Federal Motor Carrier Safety Administration's 2005 final rule that established hours of service for commercial drivers. This rule places an upper limit on the daily drive time and on-duty time to reduce the risk of fatigue-related crashes and illness in commercial vehicle operation, affecting more than three million drivers nationally.

End Outcomes

NIOSH developed training exercise saves lives during mine emergencies

NIOSH developed the Mine Emergency Response Interactive Training Simulation (MERITS) to improve the ability of mine emergency response leaders to operate a command center during a major mine emergency. MERITS is an internet delivered, computer-based exercise that simulates an emergency in a small underground coal mine. It can be used in settings with limited resources available for larger-scale mock drills, and can be used to train small numbers of individuals cost-effectively. In the fall of 2003, the Pennsylvania Bureau of Deep Mine Safety adapted this exercise for its annual refresher training for rank-and-file miners and for its training course for new miners. In testimony before the U.S. Senate Appropriations Subcommittee on Labor, Health and Human Services, and Education, David E. Hess, Secretary, Pennsylvania Department of Environmental Protection, stated that training, including this exercise, was a key factor in the success of the Quecreek mine disaster response. Copies of the exercise have been requested from safety and emergency response professionals in 28 states, the District of Columbia, and 19 foreign countries.

NIOSH research on work organization and universal (standard) precautions used to reduce injury among health care workers

In a series of studies, NIOSH partnered with Johns Hopkins University to assess work organization factors associated with worker compliance with Universal (Standard) Precautions, and then entered into cooperative agreements to develop and test work organization interventions to improve worker compliance with standard precautions to reduce exposure to HIV/AIDS. One intervention, involving worker feedback on safe work practices, was associated with fewer needlestick injuries, fewer exposures to blood and body fluids, and a higher frequency of using gloves when performing invasive procedures. In another intervention, the creation of total quality improvement (TQI) teams resulted in a 37% decline in needlestick injuries after the intervention. These NIOSH-sponsored work organization HIV/AIDS exposure studies have inspired additional intervention activities. Questions from the NIOSH studies were used in surveys of Costa Rican health care facilities, and the results used to train 3,731 workers from 14 hospitals and 19 clinics on the importance of work organization factors for improving safety and health in health care settings.

Compliance with universal precautions among health care workers at three regional hospitals
Am J Infect Control 1995 Aug;23(4):225-236

The impact of multifocused interventions on sharps injury rates at an acute-care hospital
Infect Control Hosp Epidemiol 1999 Dec; 20(12):806-811