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PubMed1991

[Relation between health status of female assemblers and the degree of occupational fatigue].

Fatigue, the functional status and morbidity of women-assemblers of the watches and shoes have been investigated. Assessment of fatigue was based on the subjective parameters. Reliable changes in morbidity were not observed in women of 20-30 years of age with a high degree of fatigue, while in the group of women of 31-40 years of age an increase in the frequency of diseases of cardio-vascular, bone-muscular and peripheral nervous systems were observed. Correlation coefficients of the degree of fatigue were 0.42 for the frequency, and 0.37 for the number of days of staying at home due to the loss of the working ability. In the group of women of 41-50 years of age this correlation is less expressed, though the morbidity level is high. The leading factors of fatigue and morbidity in these professional groups are as follows: volume and intensity of work, visual stress and low-mobility position.

Adult↗
PubMed2007

Nurses' implementation of guidelines for ventilator-associated pneumonia from the Centers for Disease Control and Prevention.

BACKGROUND: Ventilator-associated pneumonia accounts for 47% of infections in patients in intensive care units. Adherence to the best nursing practices recommended in the 2003 guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention should reduce the risk of ventilator-associated pneumonia. OBJECTIVE: To evaluate the extent to which nurses working in intensive care units implement best practices when managing adult patients receiving mechanical ventilation. METHODS: Nurses attending education seminars in the United States completed a 29-item questionnaire about the type and frequency of care provided. RESULTS: Twelve hundred nurses completed the questionnaire. Most (82%) reported compliance with hand-washing guidelines, 75% reported wearing gloves, half reported elevating the head of the bed, a third reported performing subglottic suctioning, and half reported having an oral care protocol in their hospital. Nurses in hospitals with an oral care protocol reported better compliance with hand washing and maintaining head-of-bed elevation, were more likely to regularly provide oral care, and were more familiar with rates of ventilator-associated pneumonia and the organisms involved than were nurses working in hospitals without such protocols. CONCLUSIONS: The guidelines for the prevention of ventilator-associated pneumonia from the Centers for Disease Control and Prevention are not consistently or uniformly implemented. Practices of nurses employed in hospitals with oral care protocols are more often congruent with the guidelines than are practices of nurses employed in hospitals without such protocols. Significant reductions in rates of ventilator-associated pneumonia may be achieved by broader implementation of oral care protocols.

Adult↗
PubMed1987

Ergonomics considerations in hand and wrist tendinitis.

The objectives of this article are to present (1) a historical perspective on hand and wrist tendinitis in workers, (2) new data that demonstrate a relationship between the repetitiveness and forcefulness of manual work and the prevalence of tendinitis, (3) possible biomechanical factors in tendinitis, and (4) possible job modifications for the prevention of tendinitis. Numerous studies during the last 100 years show that tendinitis is a major cause of worker suffering and workers' compensation in intensive hand work. Epidemiologic data show that the risk of hand and wrist tendinitis in persons who perform highly repetitive and forceful jobs is 29 times greater than in persons who perform jobs that are low in repetitiveness and force. A possible factor in this relationship is viscous deformation of the tendons and adjacent tissues. Although these data suggest that the risk of tendinitis among workers can be reduced by reduction of the repetitiveness and the forcefulness of the work, this hypothesis has not yet been fully tested.

Ergonomics↗
PubMed2004

Back schools in occupational health care: design of a randomized controlled trial and cost-effectiveness study.

OBJECTIVE: To describe the design of a randomized controlled trial (RCT), including a cost-effectiveness analysis, comparing high-intensity and low-intensity back schools with usual care in occupational health care. DESIGN: RCT and cost-effectiveness analysis. STUDY POPULATION: Employees sick-listed for a period of 3 to 6 weeks because of nonspecific low back pain. Interventions High-intensity back school treatment consists of a training program based on the principles of cognitive-behavioral therapy. Low-intensity back school treatment is comparable to the original Swedish Back School. Usual care is provided by the occupational physician according to the Dutch guidelines for the occupational health treatment of patients with low back pain. OUTCOME MEASURES: Primary outcome measures are return to work, pain intensity, functional status, and general improvement. Secondary outcome measures are kinesiophobia and pain coping. The cost-effectiveness analysis includes the direct and indirect costs. The outcome measures are assessed before randomization and 3, 6, and 12 months after randomization. CONCLUSION: RCTs of different methodological quality have been conducted to examine the effectiveness of back schools in occupational health care. The large variation in type, content, and intensity of back schools has led to conflicting evidence. Therefore, 2 different forms of back schools are compared. Moreover, this is the first RCT to include a cost-effectiveness analysis comparing low-intensity and high-intensity back schools with usual care in occupational health care.

Adolescent↗
PubMedDate not supplied

Work-home conflict in the European nursing profession.

This study investigated predictors of the work-home conflict among registered nurses (n = 27,603) in eight European countries. Two scales were used to assess work-family conflict (WFC) and family-work conflict (FWC). Based on a distinction of time- and strain-based and individual factors for WFC, bivariate correlations and multiple linear regression analysis were computed. The relationship between WFC and intention to leave the nursing profession was also analyzed. Quantitative demands indicating intensity of work, regularity of working time, and being pressured to work overtime were the dominating predictors for WFC, explaining 13-23% of the observed variance. The association between WFC and intention to leave the nursing profession was pronounced in all countries except one. Most European countries lack qualified nurses. Attempts to retain nurses in their profession should take into consideration the WFC, the regularity of working time in particular, and overtime issues.

Adult↗
PubMed1994

Cardiac intracellular regulation: exercise effects on the cAMP system and A-kinase.

The effects of acute and chronic exercise on 3'5'-adenosine monophosphate (cAMP) concentration, adenylate cyclase activity, cAMP-phosphodiesterase (PDE), and cAMP-dependent protein kinase (A-kinase) activity are reviewed. During very mild- to moderate-intensity exercise with durations of up to 1 h, the cAMP concentration within the myocardium is related to the intensity of exercise. At higher intensities or during very long-duration exercise, this does not seem to be the case. The mode of exercise does not seem to be a significant factor in altering cardiac cAMP concentration. Duration is more important than intensity in determining cAMP-PDE activity. Post-exercise increases in cAMP-PDE are very similar in trained animals, independent of duration and intensity of work. These increases are attenuated and less variable as compared with untrained animals. The activity of A-kinase seems to increase with exercise training. The extent of the increase in A-kinase activity is likely dependent on the duration (and perhaps the intensity) of training and is of greater magnitude than the changes in the other enzymes of the cAMP system.

Adenylyl Cyclases↗
PubMedDate not supplied

[A method of evaluating the severity of children's condition at a department of intensive therapy and resuscitation].

The condition severity was expressed by an index of clinical condition (ICC)-a score (three-point system) used for the assessment of syndrome therapy techniques for the correction of damages in five vital systems (respiration, circulation, metabolism, hemostasis, liver-kidneys). The assessment was performed 24 h after the patient was admitted into an intensive care unit. Depending on the ICC value and the potential lethal outcome the patients were entered into 4 groups. The method was tested on 347 children in three major children's hospitals in Byelorussia. The data obtained make it possible to assess objectively the work in intensive care units and analyse hospital lethality. The method suggested is adjusted for children and is simple in practical application.

Adolescent↗
PubMed2004

[Female health workers: lifestyle, work, and psychiatric disorders].

The relationships were studied between daily life, work, and mental disorders in female health workers from the Mexican Health Insurance Institute. The study sample (n = 170) included female physicians, nurses, laboratory workers, and medical assistants. Primary data were obtained through an interview which had been previously validated in a population of workers in Mexico. Relationships were found between mental disorders and all facets of women's lives. In relation to the domestic environment, women with higher rates of mental disorders were those who were mothers, had more children, did not have household help, and had husbands or partners. Prevalence of mental disorders in relation to paid work was associated with the length of the workday, absenteeism, and lack of job content. Skills development, job satisfaction, and creativity had a "protective" or preventive effect against mental disorders and fatigue. The main risks and conditions that functioned as stressors were heat, noise, physical effort, awkward positions, and intense, repetitive work.

Activities of Daily Living↗
PubMed2005

Lethal photosensitization of oral pathogens via red-filtered halogen lamp.

UNLABELLED: OBJECTIVE OF INVESTIGATION: The ability of laser irradiation in the presence of photosensitizing agent to induce lethal effect on oral bacteria is well documented. We designed an in-vitro experiment to achieve phototoxic results on two common oral pathogens, using a high intensity, red filtered halogen lamp. Our goal was to determine the minimum duration of light exposure and drug dilution to achieve at least 50% reduction in bacteria counts. METHODS: Two common oral pathogens, Porphyromonas gingivalis and Prevotella intermedia were used in experiments. The source for light energy was a continuous working, high intensity, red filtered, halogen lamp (HL) with light transmitted through a flexible light guide over petri dishes containing live bacteria. Microorganisms were exposed to light for 5, 10 and 20 min. Methylene Blue (MB) in concentrations of 0.1, 0.075, 0.05, 0.025 and 0.01% was used as a photosensitizing agent. Light energy alone and MB alone was used as controls. RESULTS AND DISCUSSION: Optimum lethal photosensitization (50% or more bacteria killing) of oral pathogens was achieved using halogen light illumination for 5 min and longer with 0.05% MB or exposure to light for 20 min in the presence of 0.025 and 0.01% MB. Light exposure of 20 min in the absence of MB was not effective in killing bacteria. In the absence of light, MB at concentrations of 0.025 and 0.001% was not effective. Reduction of bacteria with the use of 0.05% MB alone was also insignificant. However, 0.075 and 0.1% MB, even in the absence of light was found to be bacteriocidal. CONCLUSIONS: Our in-vitro data indicate that we were able to achieve lethal photosensitization of two common oral pathogens with high intensity red filtered HL in the presence of diluted MB. In this era of increased incidence of antibiotic resistance, bacterial killing with laser or light energy in the presence of photosensitizing agent can prove to be a valuable treatment modality.

Filtration↗
PubMed1997

Use of ratings of perceived exertion for predicting maximal work rate and prescribing exercise intensity in patients taking atenolol.

OBJECTIVE: The purpose of this study was to assess the efficacy of Borg's rating of perceived exertion (RPE) scale to predict maximal exercise levels to control exercise intensity in patients taking atenolol for the treatment of essential hypertension. Normally, a standard formula (220-age) is used for calculating a percentage of exercise intensity, but beta blockade can cause reductions in maximal heart rate of between 20 and 30%. METHODS: Patients were split into a control group-10 men and 10 women, aged 50 (SD 12) and 46 (9) respectively, who had risk factors for cardiovascular disease but were not taking any drugs, and a treatment group-11 men and 11 women, aged 53 (13) and 55 (13) respectively, who were established on 25-100 mg of atenolol. All patients performed two submaximal tests on a cycle ergometer. Test 1 was an estimation test, during which the RPE was reported for each increment in work rate. Test 2 was an RPE production test, during which the patient regulated the work rate according to his/her perception of effort at four predetermined points on the RPE scale (RPE 9, 13, 15, 17). RESULTS: In both tests the individual correlations (r) between RPE, heart rate, and work rate ranged from 0.96 to 0.99. Analysis of variance showed no significant difference in maximal heart rate and maximal power output for the control group when predicted from the regression lines of RPE versus heart rate and RPE versus power output in the estimation test. However, the prediction of maximal power output was lower in the women in the control group and patients in the treatment group when this was predicted from the effort production protocol (P < 0.01). When exercise intensity at each RPE was expressed relative to maximal power output there were no differences between treatment and control groups. CONCLUSION: The findings from this study confirmed the strong positive relation between RPE, heart rate, and work rate in these patients in both passive effort estimation and active effort production protocols. However, caution in applying these procedures is required because the prediction of maximal exercise levels may be lower when effort production procedures are used.

Adrenergic beta-Antagonists↗
PubMed2005

[A case of arteria cerebri aneurysm, sepsis, and miliary lung infiltrates in a 32-year-old woman].

BACKGROUND: Miliary tuberculosis is a rare manifestation of tuberculosis with a high mortality rate. Diagnosis may easily be missed when severe neurologic symptoms are the first clinical manifestation. A typical case of miliary tuberculosis is reported, with special regard to the problems of diagnostic work-up. The need for an early empirical therapy for suspected military tuberculosis is emphasized in particular. CASE REPORT: A 32-year-old Moroccan woman was admitted to the hospital with aphasia and a hemiparesis due to an intracerebral hemorrhage caused by a ruptured septic A. cerebri media aneurysm. Despite intensive work-up no septic focus could be found. Chest radiograph and computerized tomography (CT) showed miliary consolidations in the lungs. Skin testing (Tuberkulin Behring GT5) and smears for acid-fast bacilli and polymerase chain reaction (PCR) for tuberculosis of bronchoalveolar lavage (BAL) were negative. A four-drug antituberculous regimen (rifampicin [RMP], isoniazid [INH], pyrazinamide [PZA], ethambutol [EMB]) was initiated, and resulted in normalization of temperature, blood pressure, and C-reactive protein. Subsequently, cultures of BAL yielded Mycobacterium tuberculosis. The patient was discharged, a two-drug regimen was conducted (RMP, INH) after 2 months. Follow-up of the patient showed a significant improvement of the miliary lung consolidations after 5 months in CT of the lung. Only minor neurologic symptoms persisted after cessation of the therapy. CONCLUSION: In developed countries, miliary tuberculosis is a very rare cause of septic infiltrative lung disease. However, due to the nonspecific nature of the presentation and despite improved diagnostic techniques, a high clinical suspicion is essential for successful treatment.

Adult↗
PubMed2005

Work stress, smoking status, and smoking intensity: an observational study of 46,190 employees.

STUDY OBJECTIVE: To examine the relation between work stress, as indicated by the job strain model, and the effort-reward imbalance model, and smoking. SETTING: Ten municipalities and 21 hospitals in Finland. DESIGN AND PARTICIPANTS: Binary logistic regression models for the prevalence of smoking were related to survey responses of 37,309 female and 8881 male Finnish public sector employees aged 17-65. Separate multinomial logistic regression models were calculated for smoking intensity for 8130 smokers. In addition, binary logistic regression models for ex-smoking were fitted among 16,277 former and current smokers. In all analyses, adjustments were made for age, basic education, occupational status, type of employment, and marital status. MAIN RESULTS: Respondents with high effort-reward imbalance or lower rewards were more likely to be smokers. Among smokers, an increased likelihood of higher intensity of smoking was associated with higher job strain and higher effort-reward imbalance and their components such as low job control and low rewards. Smoking intensity was also higher in active jobs in women, in passive jobs, and among employees with low effort expenditure. Among former and current smokers, high job strain, high effort-reward imbalance, and high job demands were associated with a higher likelihood of being a current smoker. Lower effort was associated with a higher likelihood of ex-smoking. CONCLUSIONS: This evidence suggests an association between work stress and smoking and implies that smoking cessation programmes may benefit from taking into account the modification of stressful features of work environment.

Adolescent↗
PubMedDate not supplied

[Effect of intermittent hypoxic hypoxia on energy supply of rat skeletal muscle during adaptation to physical load].

The experiment, on Wistar male rats was carried out to investigate influence of endurance training (swimming with load 7.0 +/- 1.3% body weight, 30 min a day, during 4 weeks) and additional intermittent hypoxic training (12% O2 in N2 - 15 min, 21% O2 - 15 min, 5 sessions a day, during the first 2 weeks) on the following parameters: ADF-stimulated mitochondrial respiration, lactate/pyruvate ratio, succinate dehydrogenase activity, and lipid peroxidation in skeletal muscle. The next oxidation substrates were used: 1 mmol/l succinate and 1 mmol/l alpha-ketoglutarate as well as the next inhibitor succinate dehydrogenase 2 mmol/l malonate. It was shown that physical work combined with intermittent hypoxic training led to the increase of mitochondrial respiration effectiveness in muscle energy supply under alpha-ketoglutarate oxidation in comparison with succinate oxidation as well as to the decrease of succinate dehydrogenase activity and lipid peroxidation. The study suggested that these changes may correct mitochondrial dysfunction under intensive muscular work.

Adaptation, Physiological↗
PubMed1982

The development of critical care medicine in Singapore.

The development of critical care medicine in Singapore is similar to that in other countries. The fact that intensive care work was not centralised meant that anaesthetists had to attend to patients who were to be found all over a large hospital. Moreover, up to 1967, there was only one ventilator in the Singapore General Hospital although this was commonly used. When open-heart surgery was restarted in 1967, the need for intensive care in the post-operative patients became obvious and a post-basic intensive care nursing course was subsequently started. The quest for an area to centralise intensive care also stepped up and as space in certain wards were generously given toward this cause, intensive care further developed. With the opening of the new Singapore General Hospital, critical care medicine is certainly ready to move toward an even more sophisticated standard.

Critical Care↗
PubMed2002

VERIDOS: a new tool for quality assurance for intensity modulated radiotherapy.

BACKGROUND: The use of intensity modulated radiation fields needs an extended quality assurance concept. This consists of a linac related part and a case related part. Case related means the verification of an individual treatment plan, optimized on a CT data set of an individual patient and prepared for the treatment of this patient. This part of the quality assurance work is usually time consuming, delivers only partially quantitative results and is uncomfortable without additional help. It will be shown in this paper how the software VERIDOS will improve the optimization of the case related part of the quality assurance work. MATERIAL AND METHODS: The main function of the software is the quantitative comparison of the calculated dose distribution from the treatment planning software with the measured dose distribution of an irradiated phantom. Several additional functions will be explained. Two self-developed phantoms made of RW3 (solid water) and GAFCHROMIC films or Kodak EDR2 films for the measurement of the dose distributions were used. VERIDOS was tested with the treatment planning systems Helay-TMS and Brainscan. RESULTS: VERIDOS is a suitable tool for the import of calculated dose matrices from the treatment planning systems Helax-TMS and Brainscan and of measured dose matrices exported from the dosimetry software Mephysto (PTW). The import from other treatment planning systems and scanning software applications for film dosimetry is generally possible. In such case the import function has to be adapted to the special header of the import matrix. All other functions of this software tool like normalization (automatically, manually), working with corrections (ground substraction, factors), overlay/comparison of dose distributions, difference matrix, cutting function (profiles) and export functions work reliable. CONCLUSIONS: VERIDOS improves the optimization of the case related part of the quality assurance work for intensity modulated radiation therapy (IMRT). The diverse functions of the software offer the radiation physicist a wide base to verify the IMRT plan independent from the mode of its delivery (compensator technology or MLC technology).

Dose Fractionation, Radiation↗
PubMed1996

Respiratory muscle fatigue during exercise: implications for performance.

Heavy whole-body exercise, requiring a 10- to 15-fold increase in minute ventilation, encroaches on the capacities of the respiratory muscle system to respond. Recently, using the technique of bilateral phrenic nerve stimulation, it has been shown that heavy endurance exercise (> 85% of VO2max) lasting > 8-10 min causes diaphragmatic fatigue (15-30% reduction in transdiaphragmatic pressures when electrically stimulated at low frequencies [1-20 Hz] supramaximally). The fatigue appears to be due to an interaction of diaphragmatic work (i.e., pressure production) combined with effects related to exercise intensity (i.e., increased blood flow competition with the locomotor muscles and increased production of metabolic by-products) and requires > 60 min for recovery. Fitness (i.e., as implied from VO2max) appears to allow greater diaphragmatic work for a similar degree of fatigue. Unloading the respiratory muscles (with helium/oxygen gas or using a pressure-assist device) during heavy exercise < 90-95% of VO2max does not appear to alter exercise time, VO2max, or minute ventilation, implying that respiratory muscle fatigue plays little role in altering human performance at these work intensities. However, unloading the respiratory system with helium at work intensities > 90-95% of VO2max has been shown to improve exercise time. This would imply that respiratory muscle fatigue may play a role in limiting human performance at the extremes of human performance or that other factors related to the respiratory system (i.e., alterations in the sensation of dyspnea or mechanical load) may play an important role.

Diaphragm↗
PubMedDate not supplied

Stress in critical care nurses: actual and perceived.

OBJECTIVE: To describe the stressful work experiences and the perception of stress in female critical care nurses, and to explore possible relationships between these variables. DESIGN: A descriptive, correlational study. SETTING: Two Canadian, university-affiliated, tertiary care hospitals. SUBJECTS: A convenience sample of 96 female nurses, with at least 1 year of critical care experience, currently working in adult intensive care units. INSTRUMENTS: Subjects were administered a demographic instrument, the Critical Care Nursing Stress Scale, and the Perceived Stress Scale. RESULTS: Ranking the stressful work situations revealed that patient care-related stressors ranked the highest overall. Although lack of control appeared to be a common element among those situations ranked as the most stressful, there was considerable diversity in the stressor rankings between the individual units. There were significant correlations between perceived life stress and the perceived severity of work stressors (r = 0.296, p < 0.005), as well as between actual (frequency) and perceived (intensity) stressful work events (r = 0.50, p < 0.001). CONCLUSIONS: This study provides valuable insight into the actual and perceived stressful experiences of critical care nurses, thus contributing to the ongoing effort to reduce burnout in this population. The findings also establish a foundation for further nursing stress research in the context of the Adaptation Nursing Model.

Adult↗
PubMed1995

Different behavior of forearm blood flow during intermittent isometric handgrip in a thermo-neutral and a hot environment.

The purpose of the present study was to evaluate the different behavior of forearm blood flow (FBF) during intermittent isometric handgrip (IIHG, 6 seconds contraction +6 seconds relaxation) in a thermoneutral versus a hot environment. Six healthy men performed three times of 5-minute period IIHG at three different work loads (10%, 20% and 30% MVC). The IIHG was performed with the right hand. The experiments of IIHG were performed at two different air temperatures (25 degrees C and 40 degrees C, RH: 50%), and an experiment without work was also carried out at 40 degrees C (RH: 50%). The physiological responses measured involved heart rate (HR), cardiac output (CO), mean arterial blood pressure (MBP), FBF, and skin blood flow (SBF). HR, CO and SBF showed higher values during IIHG at 40 degrees C than at 25 degrees C. MBP had a tendency to increase with the intensity of work load at both 25 degrees C and 40 degrees C. Since intramuscular pressure might increase during contraction periods at 20% MVC and 30% MVC at 25 degrees C, FBF was significantly higher during relaxation periods than during contraction periods. FBF showed similar values between contraction and relaxation periods at 10% MVC at both temperatures. The present study suggested that FBF was sufficient for active muscles during IIHG at 10% MVC. FBF of contraction periods was close to that of relaxation periods at 40 degrees C due to the modulation of the sympathetic outflow to the muscles and/or the decreased efficiency of the muscle pump. It was suggested that FBF showed different behaviors during HHG at 25 degrees C versus at 40 degrees C.

Adult↗