Rebecca Gore - Academia.edu (original) (raw)

Papers by Rebecca Gore

PLOS ONE, Jun 15, 2023

Data Availability Statement: There are ethical and legal restrictions to the availability of our ... more Data Availability Statement: There are ethical and legal restrictions to the availability of our data. The methodology we used to categorize COVID-19 outcomes (severe versus not), comorbidities and to combine the necessary data elements for individual patients into a dataset required use of a variety of protected date fields (e.g. procedure dates, encounter dates, death dates). In addition, because these fields are extracted from an EHR, sensitive or protected health information is Conclusion Increased risk of severe COVID-19 outcomes in those < age 65 with pre-infection indicators of metabolic dysfunction heightens the importance of monitoring pre-infection indicators in younger patients for prevention and early treatment. The PCOS finding deserves further investigation. Meanwhile women who suffer from PCOS should be carefully evaluated and prioritized for earlier COVID-19 treatment and vaccination. PLOS ONE Metabolic dysfunction, polycystic ovary syndrome and risk of severe COVID-19 outcomes in patients under 65

JMIR formative research, Oct 28, 2021

Background: Process evaluation measures the context in which an outcome was or was not achieved t... more Background: Process evaluation measures the context in which an outcome was or was not achieved through the ongoing monitoring of operations. Mobile apps are a potentially less burdensome tool for collecting these metrics in real time from participants. Research-driven apps are not always developed while paying attention to their usability for target users. Usability testing uncovers gaps in researchers', developers', and users' mental models of what an efficient, effective, and satisfying product looks like and facilitates design improvement. Models may vary by user demographics. Objective: This study describes the development of a mobile app for collecting process evaluation metrics in an intervention study with health care workers that uses feedback at multiple stages to refine the app design, quantify usage based on workers' overall adoption of the app and the app's specific function, and compare the demographic and job characteristics of end users. Methods: An app was developed to evaluate the Center for Promotion of Health in the New England Workplace Healthy Workplace Participatory Program, which trains teams to develop solutions for workforce health obstacles. Labor-management health and safety committee members, program champions, and managers were invited to use the app. An accompanying website was available for team facilitators. The app's 4 functions were meeting creation, postmeeting surveys, project time logs, and chat messages. Google Analytics recorded screen time. Two stages of pilot tests assessed functionality and usability across different device software, hardware, and platforms. In stage 1, student testers assessed the first functional prototype by performing task scenarios expected from end users. Feedback was used to fix issues and inform further development. In stage 2, the app was offered to all study participants; volunteers completed task scenarios and provided feedback at deployment. End user data for 18 months after deployment were summarized and compared by user characteristics. Results: In stage 1, functionality problems were documented and fixed. The System Usability Scale scores from 7 student testers corresponded to good usability (mobile app=72.9; website=72.5), whereas 15 end users rated usability as ok (mobile app=64.7; website=62.5). Predominant usability themes from student testers were flexibility and efficiency and visibility of system status; end users prioritized flexibility andefficiency and recognition rather than recall. Both student testers and end users suggested useful features that would have resulted in the large-scale restructuring of the back end; these were considered for their benefits versus cost. In stage 2, the median total use time over 18 months was 10.9 minutes (IQR 23.8) and 14.5 visits (IQR 12.5). There were no observable patterns in use by demographic characteristics. Conclusions: Occupational health researchers developing a mobile app should budget for early and iterative testing to find and fix problems or usability issues, which can increase eventual product use and prevent potential gaps in data.

PubMed, Mar 1, 2016

Low back pain is prevalent among nursing home personnel. Safe resident handling programs (SRHP) r... more Low back pain is prevalent among nursing home personnel. Safe resident handling programs (SRHP) reduce injuries and costs. Previously, we reported variability in effectiveness and sought to identify reasons for differences among workers in resident handling equipment (RHE) use. In 8 nursing homes, nursing aides' (NAs) frequency of RHE use and reasons for inconsistent use were assessed by questionnaire up to 4 times after SRHP implementation. Ordered multinomial models examined correlates of RHE-usage frequency. At least two-thirds of NAs reported "often" or "always" lift use. Higher RHE use was related to higher SRHP commitment, higher prior SRHP expectations, older age, higher health self-efficacy, and lower supervisor support. "Device not available when needed" and "residents dislike" were major reasons consistently cited for not using RHE. While this program has been effective, attention to device availability, education of residents and family members on SRHP importance, and worker empowerment might increase usage further.

COPD research and practice, Dec 1, 2015

Background: There is little published evidence on environmental triggers of COPD exacerbation, de... more Background: There is little published evidence on environmental triggers of COPD exacerbation, despite anecdotal reports from patients and clinicians. This study gathered data on reported triggers of COPD exacerbation among a well-characterized cohort of COPD patients. We hypothesized that patient reports of irritating chemical exposures would differ depending on disease characteristics including asthma co-morbidity and COPD severity. Methods: We conducted a cross-sectional survey of 167 clinically-confirmed COPD patients who were participants in a COPD disease management program (DMG) in a large multi-specialty medical group practice. The survey included questions about specific daily activities and associated chemical exposures likely to be irritating to the respiratory system. Participants were asked whether exposure to these activities or products bothered their breathing, whether they avoided them or took additional medications to treat symptoms when exposed to them. Results: More than half of the COPD patients surveyed reported that certain common dusty activities (sweeping, vacuuming, dusting), and exposures to cigarette smoke, wood smoke, vehicle exhaust, cleaning products, perfumes and other scented products (scented candles, insect spray, hair products) adversely affected their breathing. There was evidence that COPD patients with an asthma diagnosis respond more to volatile organic compounds and those with more severe disease were more likely to report being bothered by particulate exposures. Conclusions: Common environmental exposures may adversely affect COPD patients by increasing their use of rescue medications and/or their risk of clinical exacerbation; these exposures may also lower quality of life when patients alter their activities to protect themselves from such exposures.

BMJ Open Respiratory Research, Jul 1, 2017

Public Health, Nov 1, 2018

Objectives: This study sought to evaluate whether government-assisted vs market-rate housing type... more Objectives: This study sought to evaluate whether government-assisted vs market-rate housing type influences the frequency of asthma symptoms or the quality of life scores among low-income urban children. In addition, the study sought to evaluate whether housing type influenced the success of in-home environmental and educational interventions in improving children's asthma symptoms or quality of life scores. Study design: This was a before-and-after intervention design. Comprehensive health and environmental assessments and subsequent interventions were completed in 176 lowincome households with 257 asthmatic children living in government-assisted housing and market-rate housing in Lowell, Massachusetts. Methods: We collected environmental and health data with questionnaires at a baseline and a 12-month follow-up visit using the Children's Health Survey for Asthma and a walkthrough environmental checklist. Education, tools to remove asthma triggers from the home, and home repairs and remediation were included in the interventions.

Environmental health perspectives, Sep 13, 2011

Background and Aims: A retrospective exposure assessment was conducted as part of an epidemiologi... more Background and Aims: A retrospective exposure assessment was conducted as part of an epidemiologic study of the morbidity and mortality of workers exposed to C8, the ammonium salt of perfluorooctan...

American Journal of Industrial Medicine, Aug 28, 2018

Purpose: Approximately 25-30% of nursing personnel experience knee pain (KP). We sought to identi... more Purpose: Approximately 25-30% of nursing personnel experience knee pain (KP). We sought to identify physical and psychosocial work exposures, and personal factors related to prevalent, incident, and persistent KP 5-8 years after safe resident handing program (SRHP) implementation in nursing homes. Methods: Health and exposure information was obtained from worker surveys 5-6 years ("F5") and 7-8 years ("F6") post-SRHP implementation. Prevalent KP correlates were examined at F5; persistent and incident KP predictors were analyzed at F6, utilizing robust Poisson multivariable regression. Results: F5 KP prevalence (19.7%) was associated with combined physical exposures, and with either high job strain or low social support, in separate models. Two-year persistent KP was

Home Health Care Management & Practice, Dec 11, 2020

Home health and home care (HH&HC) agencies provide essential medical and supportive services to e... more Home health and home care (HH&HC) agencies provide essential medical and supportive services to elders and people with disabilities, enabling them to live at home. Home-based care is an important alternative to facility-based care, especially for infection prevention during the COVID-19 pandemic. The majority of the HH&HC workforce is comprised of aides, who also are vulnerable to COVID-19. There are limited data on the COVID-19 experience of HH&HC agencies, clients and aides. A survey of Massachusetts HH&HC agency managers was conducted June 1 to 30, 2020 to assess the impact of COVID-19 on agencies, clients, and aides early in the pandemic and to identify needs for future pandemic planning. Of the 94 agencies with completed surveys, most (59.6%) provided services to clients with COVID-19 and 3-quarters (73.7%) employed aides who tested positive for COVID-19, were symptomatic, and/or quarantined. Most agencies (98.7%) experienced a decrease in demand for home visits, reflecting clients' concern about infection, family members assuming care duties, and/or aides being unavailable for work. Simultaneously, managers' workloads increased to develop more extensive infection prevention policies, procedures and workforce training and sourcing scarce personal protective equipment (PPE). The COVID-19 pandemic imposed substantial new infection prevention responsibilities on HH&HC agencies, clients, and aides. Specific HH&HC needs for future pandemic planning include complete information on the infection status of clients; ready access to affordable PPE and disinfectants; and guidance, tools, and training tailored for the industry. HH&HC should be incorporated more fully into comprehensive healthcare and public health pandemic planning.

Journal of Occupational and Environmental Medicine, Oct 28, 2022

Annals of Work Exposures and Health, Feb 19, 2021

Alteration of the hypothalamic-pituitary-adrenal (HPA) axis hormones has been associated with a r... more Alteration of the hypothalamic-pituitary-adrenal (HPA) axis hormones has been associated with a range of chronic metabolic and cardiovascular health conditions. This study evaluated whether type of farming (organic versus conventional) or the number of self-reported days of spraying pesticides in the past 8 months was associated with diurnal cortisol levels. Salivary cortisol levels were measured four times a day (waking, 30 min after waking, 6 h after waking and bedtime) longitudinally, 8 months apart during three rounds of data collection. Pesticide using (conventional) and organic farmers were recruited to participate. Pesticide use in the previous 8 months was determined as the number of spray days for each type of pesticide used (herbicide, insecticide, fungicide) from selfreported questionnaires. Estimates of cortisol levels at four time points, the cortisol awakening response (CAR), and the diurnal cortisol slope (DCS) were estimated with a longitudinal mixed model that accounted for the non-linearity of cortisol levels across the day. Conventional farmers had significantly lower cortisol levels at waking than organic farmers (3.39 versus 3.86 ng ml −1), 30 min after waking (5.87 versus 6.96 ng ml −1), 6 h after waking (1.62 versus 1.88 ng ml −1), and lower diurnal cortisol slope (−2.26 versus −2.51 ng ml −1). Farmers who frequently applied herbicides (90th percentile of the number of spray days in the past 8 months) had significantly lower waking, 30 min after waking, 6 h after waking, bedtime and diurnal cortisol slopes compared with those with no spray days of herbicide in the past 8 months (organic and some of the conventional farmers). Those who frequently applied insecticides in the past 8 months had significantly lower bedtime levels and diurnal cortisol slopes, compared with those with no spray days of insecticide in the past 8 months. There were no significant differences in cortisol hormones between those who frequently applied

Journal of Occupational and Environmental Medicine, Apr 7, 2020

The aim of this study was to investigate risk factors for retinal detachment or tear (RD/T), and ... more The aim of this study was to investigate risk factors for retinal detachment or tear (RD/T), and follow up two studies that found increased risk from work-related heavy lifting. Methods: We conducted a case-control study including 200 cases of RD/T and 415 controls. Participants completed a questionnaire covering general health, vision, and physical exertion. Multiple logistic regression and propensity score matching was used to control confounding and estimate independent effects. Results: RD/T risk was increased by one lifting measure: current regular lifting of more than 30 lbs (>13.6 kg). In the population aged less than 65 years, the odds ratio comparing those with/without heavy lifting was 1.81, 95% confidence interval = 1.08 to 3.04. Conclusion: Occupational heavy lifting may represent a risk factor for RD/T, but further research is needed in populations with frequent heavy physical exertion to more precisely quantify the risk.

Objectives We developed a conceptual framework, called the Care Bond (CareBond), to describe the ... more Objectives We developed a conceptual framework, called the Care Bond (CareBond), to describe the relationship between healthcare worker and patient safety during the delivery of care and how psychosocial, work organisational and other occupational safety and health (OSH) factors can impact this relationship. We applied the framework in a population of home care (HC) aides in order to: 1) determine whether the CareBond could be measured quantitatively and 2) test the hypothesis that OSH factors can influence the CareBond. Methods We developed the CareBond framework based on our previous studies and a review of the scientific literature. We evaluated the CareBond using a questionnaire in a cross-sectional survey of HC aides. Questionnaire responses used to measure dimensions of the CareBond were analysed using Principal Components Analysis; impacts of OSH factors on the CareBond were evaluated using Poisson regression. Results 1,249 HC Aides completed the questionnaire and contributed information on 3,484 patient care visits. Three major dimensions of the CareBond were identified: HC worker safety, patient safety and collaboration. OSH conditions that weakened the CareBond included lack of equipment for patient mobility, prevalence ratio (PR) = 0.94; 95% confidence interval (CI) = 0.90, 0.99; experiencing slip, trip and falling hazards during the patient care visit (PR = 0.68; CI = 0.57, 0.81); presence of uncontrolled pets (PR = 0.78; CI = 0.64, 0.94); catching a patient while falling (PR = 0.94; CI = 0.87, 1.02); caring for a patient on home dialysis (PR = 0.70; CI = 0.52, 0.95); requirement of mopping the floors during the patient care visit (PR = 0.94; CI = 0.89, 1.00); and exposure to faeces (PR = 0.90; CI = 0.84, 0.97). Conclusions The CareBond is a promising framework for characterising and quantifying the connexion between HC worker and patient safety. Factors that weaken the CareBond can be targeted for preventive interventions to improve OSH and quality of care.

Advances in intelligent systems and computing, Aug 11, 2018

Monitoring of workplace intervention processes in real-time can identify factors influencing inte... more Monitoring of workplace intervention processes in real-time can identify factors influencing intervention success or failure while they can still be modified if necessary. The aims of this study are to describe a process to assess and (where necessary) improve functionality and usability of a process evaluation mobile app. The app was developed for the research study “Safety and Health through Integrated, Facilitated Teams” (SHIFT), an evaluation of the CPH-NEW Healthy Workplace Participatory Program in public sector healthcare institutions. App users are members and co-facilitators of labor-management health and safety committees, internal program champions, other managers, and researchers. The app records four “functions:” meetings held, attendance and attendee feedback; project-related chats; and time spent on project activities. Post-meeting feedback surveys cover participant engagement, group dynamics, and usefulness of the intervention at each step. Pilot tests were conducted across combinations of device specifications to assess both functionality and usability. Functionality problems were fixed as they were documented. The average System Usability Scale scores for seven student testers were similar between the two interfaces: 72.9 for the mobile app and 72.5 for the website, both corresponding to “good” usability. Development of a mobile app requires substantial effort and personnel time which may not be apparent at the start of the project. Communication between researchers and the app developer was challenging at times. Conceptual and mental models of the specifications do not necessarily correspond due to differences in fields, experience, and priorities.

Diagnostics, 2022

During the COVID-19 public health emergency, many actions have been undertaken to help ensure tha... more During the COVID-19 public health emergency, many actions have been undertaken to help ensure that patients and health care providers have timely and continued access to high-quality medical devices to respond effectively. The development and validation of new testing supplies and equipment, including collection swabs, has helped to expand the availability and capability for various diagnostic, therapeutic, and protective medical devices in high demand during the COVID-19 emergency. Here, we report the initial validation of a new injection-molded anterior nasal swab, ClearTip™, that was experimentally validated in a laboratory setting as well as in independent clinical studies in comparison to gold standard flocked swabs. We have also developed an in vitro anterior nasal tissue model which offers a novel, efficient, and clinically relevant validation tool to replicate the clinical swabbing workflow with high fidelity, while being accessible, safe, reproducible, and time- and cost-ef...

Journal of Occupational and Environmental Hygiene, 2021

Abstract Home care (HC) aide visits to clients’ homes often involve cleaning and disinfecting (C&... more Abstract Home care (HC) aide visits to clients’ homes often involve cleaning and disinfecting (C&D) bathrooms. Some ingredients in C&D household products are associated with respiratory illness, including sodium hypochlorite (bleach) and quaternary ammonium compounds (quats). “Green” products may be safer for the environment, however there are limited quantitative evaluations of their respiratory risks. This study assessed airborne concentrations and time profiles of total volatile organic compounds (TVOC) and chlorine generated during typical bathroom cleaning performed by aides using conventional and green products. Aides performed cleaning tasks in a simulated residential bathroom constructed in an environmental air sampling laboratory. A balanced experimental design involved each aide coming to the lab for four visits during which she performed two 20-min cleaning sessions using one of three C&D products (bleach-based, 1–5% sodium hypochlorite by weight; quats-based, 0.1–1% by weight quaternary ammonium compounds; and “green,” 0.05% by weight thymol, a component of botanical thyme oil) or distilled water as a control. TVOC and chlorine direct reading instruments were attached to aides with sample inlets located in the breathing zone. Ten-second averages of TVOC and chlorine gas concentrations and instantaneous peak concentrations were recorded for the sessions’ duration. TVOC concentrations by methods of C&D application (spraying, streaming, wiping) also were evaluated. The study completed 169 air sampling sessions with 22 aides. The quats-based product generated more than twice the average TVOC concentrations (mean = 1,210 ppb) than the bleach-based (mean = 593 ppb) or green (mean = 498 ppb) products. Each product generated TVOC concentrations that rose rapidly within the first few minutes of application. Spraying produced the highest TVOC exposures, wiping the lowest. Thirteen aides (65%) experienced peak chlorine exposures above the OSHA PEL ceiling limit (1 ppm) when using the bleach-based product. HC aides may experience respiratory hazards from use of conventional or green C&D products formulated with bleach or other respiratory irritants and sprayed in small, poorly ventilated spaces typical of bathrooms. Spraying should be avoided.

Occupational and Environmental Medicine, 2019

ObjectiveViolence from care recipients and family members, including both verbal and physical abu... more ObjectiveViolence from care recipients and family members, including both verbal and physical abuse, is a serious occupational hazard for healthcare and social assistance workers. Most workplace violence studies in this sector focus on hospitals and other institutional settings. This study examined verbal abuse in a large home care (HC) aide population and evaluated risk factors.MethodsWe used questionnaire survey data collected as part of a larger mixed methods study of a range of working conditions among HC aides. This paper focuses on survey responses of HC aides (n=954) who reported on verbal abuse from non-family clients and their family members. Risk factors were identified in univariate and multivariable analyses.ResultsTwenty-two per cent (n=206) of aides reported at least one incident of verbal abuse in the 12 months before the survey. Three factors were found to be important in multivariable models: clients with dementia (relative risk (RR) 1.38, 95% CI 1.07 to 1.78), home...

Safety and Health at Work, 2018

Background: Nursing home resident care is an ongoing topic of public discussion, and there is gre... more Background: Nursing home resident care is an ongoing topic of public discussion, and there is great interest in improving the quality of resident care. This study investigated the association between nursing home employees' job satisfaction and residents' satisfaction with care and medical outcomes. Methods: Employee and resident satisfaction were measured by questionnaire in 175 skilled nursing facilities in the eastern United States from 2005 to 2009. Facility-level data on residents' pressure ulcers, medically unexplained weight loss, and falls were obtained from the Centers for Medicare and Medicaid Services Long-Term Care Minimum Data Set. The association between employee satisfaction and resident satisfaction was examined with multiple and multilevel linear regression. Associations between employee satisfaction and the rates of pressure ulcers, weight loss, and falls were examined with simple and multilevel Poisson regression. Results: A 1-point increase in overall employee satisfaction was associated with an increase of 17.4 points (scale 0e100) in the satisfaction of residents and family members (p < 0.0001) and a 19% decrease in the incidence of resident falls, weight loss, and pressure ulcers combined (p < 0.0001), after adjusting for staffing ratio and percentage of resident-days paid by Medicaid. Conclusion: Job satisfaction of nursing home employees is associated with lower rates of resident injuries and higher resident satisfaction with care. A supportive work environment may help increase quality of care in the nation's nursing homes.