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PubMed1983

Lead exposure and nerve conduction velocity: the differential time course of sensory and motor nerve effects.

Nerve conduction velocities (NCV) of the median motor, median sensory, peroneal motor, and sural nerves were measured on 40 lead-exposed automobile production workers as part of a comprehensive health survey. Blood lead (Pb-B) and blood zinc protoporphyrin (ZPP) were measured. The control group (N = 31) consisted of workers without lead exposure. All subjects were screened for the following conditions: Limb, neck or back injury, diabetes, neurological disease, and alcohol consumption of more than 28 alcoholic beverages per week. Limb temperature was assessed at three sites for each NCV measurement. The lead-exposed workers had slower median sensory NCV (42.9 vs. 46.8 m/sec, p less than 0.006) and slower sural NCV (37.8 vs. 42.8 m/sec, p less than 0.0004). All NCV estimates were then statistically adjusted for age and temperature, and transformed to Z values for further analyses. The mean standardized NCVs were slower in the lead-exposed group for the median sensory (-1.03 vs. -0.04, p less than 0.0003) and the sural nerves (-2.52 vs. -0.52, p less than 0.001). The study group was divided into two groups, with less than ten years and more than ten years of lead exposure. The subsample exposed less than ten years showed slowing of the median sensory (-0.94 vs. -0.04, p less than 0.005) and the sural nerves (-2.42 vs. -0.52, p less than 0.0001). Pb-B and ZPP levels were correlated with sural velocity (r = -0.54, p less than 0.04, and 4 = -49, p less than 0.06, respectively. Mean Pb-B was 59.7 micrograms/dl and mean ZPP was 175.8 micrograms/dl).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Inter- and intraexaminer reliability of a single, digital inclinometric range of motion measurement technique in the assessment of lumbar range of motion.

OBJECTIVE: The between and within examiner reliability of a range of motion digital inclinometer was evaluated for lumbar flexion, extension and right and left lateral flexion. DESIGN: Blinded, lumbar range of motion instrumentation reliability. SETTING: Private college research and ambulatory patient care facility. PARTICIPANTS: Twenty-eight asymptomatic persons recruited from a private college. This included students, staff and faculty that ranged from 23-36 yr, with no history of back pain or surgery or back injury 6 wk prior to entry into the study. INTERVENTION: Lumbar range of motion examination, twice by each examiner, or four times in all per subject. MAIN OUTCOME MEASURE: Lumbar range of motion, measured in degrees. RESULTS: Intraclass correlation (ICC) revealed lack of reliability for this device except flexion, but intrinsic limitations of the instrument suggests that flexion as well may not be reliable. The p value of .05 was used for statistical significance and Burdock's recommended value of .75 represented the minimum R value for reliability. CONCLUSION: Most of the reliability values did not meet Burdock's recommended minimum R value, and the R values for flexion may have met minimum criteria due to intrinsic limitations of the instrument itself. Due to the findings of this study, we conclude that the Orthoranger II digital inclinometer is not reliable, between and/or within examiners, for measuring lumbar flexion, extension or lateral flexion. Because there was evidence to suggest other variables which were not accounted for, and which could have affected final results, the development of a streamlined protocol may result in more consistent findings. Further research is needed to either support or dispute these results before this instrument can be recommended as an assessment tool in clinical practice or in clinical trials.

Adult↗
PubMed1996

Stressful nurses: the effect on patient outcomes.

The article describes a study that measured, over a 3-month period, staffing problems, including turnover rates; nurse incidents, including absenteeism, back injuries, and needle sticks; and patient incidents, including falls and medication errors. The self-reported stress of the nurses caring for these patients was recorded over the same 3-month period. Data showed that a relatively strong relationship exists between a hospital unit's Stress Continuum Scale (SCS) and the occurrence of patient incidents. The relationship between the SCS and personal incidents and nurse injuries appears weak, as does the relationship between staff turnover and stress. Lagging staff turnover by 1 month resulted in a moderate association with the SCS, however.

Burnout, Professional↗
PubMed1996

Posterior bow and vanishing line signs in diagnosis of burst fractures of the spine on plain radiographs.

It is not uncommon to misdiagnose a burst fracture as a wedge compression fracture initially on plain film, resulting in a late progressive deformity and neurologic damage. The purpose of this study was to analyze the sensitivity, specificity and positive predictive value of plain radiographs in the diagnosis of thoracic and lumbar burst fractures using the posterior bow (PB) and vanishing line (VL) signs. Seven independent examiners, comprising three chief orthopedic residents, two radiologic third-year residents and two emergency attending physicians (orthopedists), randomly reviewed 26 sets of admission anteroposterior and lateral thoracolumbar spine radiographs taken in association with back injuries. They were asked to decide whether patients had a burst or a wedge compression fracture. All patients had computed tomography (CT) scans for diagnostic confirmation. The overall initial sensitivity using discriminant analysis in the diagnosis of burst fractures was 80%. This increased to 90% after the examiners were requested to use the PB and VL signs. The specificity decreased slightly from 75% to 71%, while the positive predictive value remained at 88%. Overdiagnosis of wedge compression fractures as burst fractures occurred, especially when the quality of the films was not ideal. We conclude that, with careful reading, the PB and VL signs help in identifying burst fractures on the initial plain film evaluation.

Adult↗
PubMed1996

A work site wellness program.

As a result of a Work Site Wellness Program, 67% of the employees who participated improved their health status. The indicators most often met included: elimination of back injury, consistent use of seat belts, nonsmoking behaviors and reduction in blood pressure, cholesterol and percent body fat.

Female↗
PubMedDate not supplied

Know how. Kinetic therapy.

It is normal practice for patients in intensive care units to be turned regularly--every two hours, or more, depending on their medical condition and at-risk status. Manual turning makes high demands on nursing time and can result in a high incidence of back injuries. The introduction of kinetic therapy as a means of keeping patients moving is proving beneficial in both intensive care and high-dependency care settings to patients and their carers. It is a therapy that can be initiated by both nursing and medical staff.

Beds↗
PubMed1997

Canterbury community nurses tackle. Manual handling.

In 1994 the Canterbury Council developed an Occupational Health and Safety Strategic Plan for the Community Service Division. One of the issues identified was the risk involved in the manual handling being carried out by community nurses in the home setting. It was decided to examine the current manual handling policy and procedures and develop a program to look at ways to reduce risk. There had been two workers' compensation claims for back injuries during 1995.

Community Health Nursing↗
PubMed1997

A hypertension control program tailored to unskilled and minority workers.

PURPOSE: A comprehensive worksite health promotion program designed to reduce risk factors for cardiovascular disease among 4000 city of Birmingham employees was used to develop and implement a tailored antihypertensive educational intervention. The mean age of the underlying population was 36 years, 89% were blue-collar or unskilled workers, 50% were African Americans and 20% were female. METHODS: First, we identified barriers to hypertension control: low literacy, difficulty understanding the need for treatment of asymptomatic disease, and wide variability of health beliefs and priorities. We then tailored an educational program, which offered employees health education sessions on a variety of different topics, including heart disease, cancer, sleep disorders and back injury. All program materials focused on lifestyle changes and the need to seek medical care. This program was offered to all hypertensive workers; 130 chose to enroll, and 81 completed the program. These 81 participants were matched by age, sex, race and baseline BP with nonparticipating hypertensive workers (controls). Changes in SBP and DBP from before to after the educational program were used to evaluate the program. RESULTS: Overall, intervention participants had a decrease of 4.5 mm Hg in mean SBP (different from zero, [p = 0.03]). African American participants showed a significant decrease (7.4 mm Hg, [p = 0.004]), as did unskilled intervention participants (SBP changes = 7.7 mm Hg, [p = 0.004]). Although not statistically significant, controls showed decreases in BP in the same direction. CONCLUSION: An educational intervention tailored to the specific health perceptions and working conditions of a low literacy population is feasible, and may have a significant effect on hypertension control.

Adult↗
PubMed1998

Quality-of-life in technology-dependent children receiving home care, and their families--a qualitative study.

PURPOSE: This qualitative study explored quality-of-life (QL) issues among Wisconsin's technology-dependent children and their families. METHODS: Five semi-structured focus groups were held with parents, siblings and health care workers of home-dwelling children dependent upon technology such as tracheostomy, ventilator support and gastrostomy tube feedings. Focus group transcripts were analyzed using an editing style format, with each author as an independent analyst. RESULTS: QL for the child was seen as a relative term, defined within the family, dependent upon the availability of services; and expressed in terms of physical comfort and function, and integration of the child into the family and community. Positive QL aspects for families include: growth as individuals, intrinsic rewards from the child and appreciation of others with handicaps. Negative impacts on family QL include: physical and mental anguish (e.g., exhaustion, suicidal ideation, back injuries), inhibitions of normal family functions, and isolation. Home nursing was highly valued despite lack of privacy. A number of ethical issues emerged including ineffective communication and lack of QL discussions during the child's acute treatment, end-of-life decisions, and potential cuts in Medicaid services. The latter issue prompted fear of poverty and divorce among siblings. CONCLUSIONS: Technology appears to exceed the sociological and ethical components of the care of these children, and QL is defined in terms of physical comfort, functional status, adequate services, and family/community integration. Parents assume an ambiguous medical role with their child, and need respite care and advocacy from their health care team.

Adult↗
PubMed2002

The effects of a medical care utilization review program on back and neck injury claims.

A number of quality-based evaluation and treatment protocols have been developed and marketed for the management of work-related musculoskeletal problems. Yet, little is known about their effectiveness in improving patient outcomes. We evaluated one such approach adopted by the Department of Labor and Industries, which insures approximately two-thirds of the non-federal workforce in Washington State. The outcomes of back and neck injury claims (primarily sprains and strains) filed in the 2 months after the program was fully operational were compared with two comparable groups of claims from the same base population filed before the program's availability. There were no statistically significant differences between groups in the number of days of work loss, medical costs, and permanent partial disability awards granted during the 2 years after injury. The quality-based program used as an adjunct to claims management failed to improve outcomes.

Absenteeism↗
PubMed1989

"Back" to basics.

Most back-related injuries can be tied to poor posture, lack of physical conditioning, stress, and other environmental factors. Many back-injury prevention strategies focus on improving these areas, plus instructing on proper posture, body mechanics, and lifting techniques. For these techniques to be practical and useful, they must be taught through demonstration and practice in a controlled environment. The benefits of a back-injury prevention program include feeling more physically fit, balanced, and in control. Training will improve performance at work and home, and can also be used to protect family members from these common, devastating injuries.

Allied Health Personnel↗
PubMed1990

Pediatric injuries in the back of pickup trucks.

Travel in the back of pickup trucks has not been adequately addressed as an occupant protection issue. This study compares injuries sustained by children riding in the back of pickup trucks with those of children riding in the cab. Data were obtained from a multihospital monitoring system and the coroner in a single urban county. The series of injured children consisted of 290 children 0 through 14 years of age, 201 of whom had been riding in the cab and 89 in the back. Age distribution of the children demonstrated that it is most frequently the 10- to 14-year-olds who travel in the back. Children riding in the back were more frequently injured in noncrash events (absence of a collision), had more ejections, had more injuries, and sustained more severe injuries as measured by the Maximum Injury Score. With increased restraint use in the cab, it is likely that even greater differentials in injury severity and patterns would be realized. Education regarding the hazards of travel in the back of pickups and stronger legislation limiting the transport of children in the back of trucks are recommended.

Accidents, Traffic↗