Occupational health for health Care workers
Literature Follow-up – October - November
- Institute of Occupational Health - Rouen University Hospital
Table of Contents
for Occupational Health for Health Care Workers
the hands-free technique in reducing operating theatre injuries
Avoiding blood and
body fluid exposures
and health care workers
hepatitis B vaccines: implications of immune memory
The Effect of Age
on Immunologic Response to Recombinant Hepatitis B Vaccine: A Meta-analysis
How medical students
in their pre-clinical year perceive their own hepatitis-B-virus status: the
results of a study in a Thai medical school
An Outbreak of Group
A Streptococcal Infection among Health Care Workers
A historical review
of barrier materials
professionnal to patient
for HIV-infected clinicians
Nurses to be tested
of the sentinel lymph node: dosimetric evaluation in personnel involved in
Feasibility of lumbar
supports for home care workers with low back pain
[Risks related to
cytostatic exposure for nursing staff
[A case of pneumoconiosis
in a dental technician
in health care personnel
and compensation of occupational dermatitis
total mercury levels among Lebanese dentists
Stress – Mental
Hospital Nurse Staffing
and Patient Mortality, Nurse Burnout, and Job Dissatisfaction
and burnout among staff of homes for the elderly
Launches New Initiative Against Workplace Violence in the Health Sector.
Children With Physical
Disabilities Compared With Female Caregivers of Children With a Chronic Medical
Inequity in occupational
health services for government hospital workers in South Africa
The perceived function
of health care assistants in intensive care: nurses views
in mental health: are clinicians doing enough for undergraduate nursing students?
How one hospital and two systems cured their staffing ills
lived experience of advocacy within a critical care unit: a phenomenological
Effects of shiftwork
on sleep and menstrual function in nurses
Your health at work
Evidence Based Medicine
Safety and Health
Good Practice on-line for the Healthcare Sector
Documents en Français
infections invasives à méningocoque
Sécurité des médecins
associés au vaccin antigrippal : résultats de la surveillance passive, Canada
Premier cas de diphtérie
depuis 1989 en France
Autopsie de la RTT
B : la polémique repart
of Health Personnel
Medline search using above
Systematic follow-up of
Stringer B, Infante-Rivard
C, Hanley JA.
theatre personnel are at increased risk for transmission of blood borne pathogens
when passing sharp instruments. The hands-free technique, whereby a tray or
other means are used to eliminate simultaneous handling of sharp instruments,
has been recommended. AIMS: To prospectively evaluate the effectiveness of
the hands-free technique in reducing the incidence of percutaneous injuries,
contaminations, and glove tears arising from handling sharp instruments. METHODS:
For each of 3765 operations carried out in main and surgical day care operating
theatres in a large urban hospital, over six months, circulating nurses recorded
the proportion of use of the hands-free technique during each operation, as
well as other features of the operation. The hands-free technique, considered
to be used when 75% or more of the passes in an operation were done in this
way, was used in 42% of operations. The relative rate of incidents (percutaneous
injuries, contaminations, and glove tears) in operations where the hands-free
technique was used and not used, with adjustment via multiple logistic regression
for the different risk profiles of the two sets of operations, was calculated.
RESULTS: A total of 143 incidents (40 percutaneous injuries, 51 contaminations,
and 52 glove tears) were reported. In operations with greater than 100 ml
blood loss, the incident rate was 4% (18/486) when the hands-free technique
was used and 10% (90/880) when it was not, approximately 60% less. When adjusted
for differences in type and duration of surgery, emergency status, noisiness,
time of day, and number present for 75% of the operation, the reduction in
the rate was 59% (95% CI 23% to 72%). In operations with less than 100 ml
blood loss, the corresponding rates were 1.4% (15/1051) when the hands-free
technique was used and 1.5% (19/1259) when it was not used. Adjustment for
differences in risk factors did not alter the difference. CONCLUSIONS: Although
not effective in all operations, use of the hands-free technique was effective
in operations with more substantial blood loss.
Jagger J, Perry J.
International Health Care
Worker Safety Center of the University of Virginia at Charlotesville, USA.
Nursing 2002 Aug;32(8):68
Ciuffa V, Tirrozzo SF,
Arch Intern Med 2002 Oct
Comment on: Arch Intern
Med. 2002 Feb 11;162(3):345-50.
Vaccine 2002 Nov 1;20(31-32):3695-701
The subunit recombinant
hepatitis B virus (HBV) vaccines available in the US differ in hepatitis B
surface antigen content. Clinical studies have linked higher antigen formulations
with enhanced peak protective antibody levels. This is important for the elderly,
smokers, the obese, and the immunocompromised. Immune memory, which is responsible
for prolonged protection when HBV vaccine-induced antibody levels become undetectable,
may be related to antigen persistence on immunologically active cells. Antigen
persistence may be related to antigen content of the vaccine and thereby influences
the duration of immunity. Proof of this concept will require additional studies
of immune memory in HBV.
David N. Fisman, Deepak
Agrawal, and Karin Leder
Clinical Infectious Diseases
Hepatitis B vaccine is
a key tool for the prevention of hepatitis B infection. Age-associated changes
in immune function may contribute to decreased vaccine efficacy in older individuals,
although research related to this topic has yielded contradictory findings.
We performed a meta-analysis of 24 published trials and studies that evaluated
the association of age with response to hepatitis B vaccine, using a random-effects
model. Pooling of study results suggested a significantly increased risk of
nonresponse to hepatitis B vaccine among older individuals (relative risk
[RR], 1.76; 95% confidence interval [CI], 1.482.10). An elevated risk of nonresponse
persisted even after exclusion of poor-quality studies (RR, 1.63; 95% CI,
1.232.15) and adjustment for publication bias (RR, 1.52; 95% CI, 1.261.83),
and it was present even when "older" individuals were defined as
being as young as 30 years. These findings have important implications for
individuals at risk for hepatitis B infection, including health care workers
Department of Laboratory
Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand.
Ann Trop Med Parasitol
In 2000 all of the medical
students of the Faculty of Medicine at Chulalongkorn University in Bangkok
who were then in their pre-clinical year were interviewed about their hepatitis-B-virus
(HBV) status. Of the 215 interviewees, 125 (58.2%) claimed to know their HBV
status. Seventy (32.6%) of the subjects assumed they were immune because they
had already been vaccinated against the virus, 32 (14.9%) claimed to have
natural immunity following exposure to the virus, and 14 (6.5%) reported that
they were HBV carriers. Another five (2.3%) of the subjects said they had
been tested for HBV and found seronegative and the remaining four subjects
(1.9%) who said they knew their status declined to give any more details.
The 90 subjects who did not know their status were all offered HBV screening,
and 62 agreed to be tested, both for the surface antigen of the virus (HBsAG)
and antibody to the viral core (anti-HBc). These tests revealed that 37 subjects
were seronegative (negative for both HBsAg and anti-HBc), 11 appeared to have
natural immunity (negative for HBsAg but positive for anti-HBc) and the other
14 were carriers (positive for HBsAg but negative for anti-HBc). Four of the
14 carriers were also positive for the HBV 'e' antigen (HBeAg), indicating
that they were highly infectious. Medical students form a high-risk group
for infection with blood-borne pathogens, including HBV. That more than 40%
of the pre-clinical students in the present study did not know their HBV status
and fewer than 50% had been vaccinated against the virus are therefore causes
for concern. Those students entering Thai medical schools for the first time
clearly need to be better educated about hepatitis B and to be encouraged
to be vaccinated before they begin any clinical practices.
Anthony Kakis, Laurel
Gibbs, Jose Eguia, Joe Kimura, Diane Vogelei, Nancy Troup, Dennis Stevens,
Edward L. Kaplan, Dwight R. Johnson, and John E. Conte, Jr.
Clinical Infectious Diseases
We describe the nosocomial
transmission of group A Streptococcus species (GAS) from a single source patient
to 24 health care workers (HCWs). DNA typing revealed that all of the isolates
were identical to that of the source patient. The isolates were M type 1,
positive for production of nicotine adenine dinucleotidase, and negative for
opacity factor, all of which are factors reported to have a higher correlation
with invasive disease. The 24 HCWs developed symptoms of pharyngitis 4 days
after exposure to the source patient. Nosocomial transmission occurred 25
h after exposure to the source patient, before the institution of outbreak-control
measures. A questionnaire was distributed to HCWs to help identify the factors
responsible for the high attack rate among those who were exposed. Invasive
GAS disease in a nosocomial setting can be highly transmissible. Rapid identification,
early treatment, and adherence to infection-control practices may prevent
or control outbreaks of infection.
AORN J 2002 Oct;76(4):648-53
When surgical gowns first
were used, their primary purpose was to protect patients from members of the
surgical team. In 1952, it was revealed that although the muslin the garments
were made from may have been an effective barrier when dry, it lost barrier
capability after it became wet. This disclosure triggered research to develop
more satisfactory materials for this unique application. In the interim, the
emergence of HIV was accompanied by the need to protect surgical team members
from patients, and barrier effectiveness attained even greater importance.
During the past 50 years, several attempts have been made to develop a universally
acceptable and meaningful test method to demonstrate a material's barrier
capability under conditions that simulate usual conditions of use. None has
been successful. Today, with the trend toward minimally invasive surgery and
pressure to reduce costs, perioperative nurses are confronted with selecting
a product that is appropriate for the task and degree of exposure anticipated.
Publication Types: Historical
Article Review Review, Tutorial
HIV Clin 2002 Fall;14(4):1,
Br J Perioper Nurs 2002
- Smallpox Response Plan and Guidelines (Version 3.0)
CDC has released an updated
version of the post-event Smallpox Response Plan and Guidelines. This is the
second revision to these guidelines since they were released in November 2001.
Version 3 of the guidelines
contains an important additionthe "Smallpox Vaccination Clinic Guide."
This guide provides the operational and logistical considerations associated
with implementing a large-scale, voluntary vaccination program as part of
a multifaceted response to a confirmed smallpox outbreak. Following a confirmed
smallpox outbreak within the United States, rapid, voluntary vaccination of
a large segment of the population might be required to (1) supplement priority
surveillance and containment control strategies in areas with smallpox cases,
(2) reduce the at-risk population for additional intentional releases of smallpox
virus if the probability of such occurrences is considered significant, and
(3) address heightened public concerns about access to voluntary vaccination.
The most important component
of smallpox containment is the rapid identification, isolation, and vaccination
of close contacts of infected patients and contacts of their contacts (i.e.,
ring vaccination). This strategy involves identification of infected persons
through intensive surveillance, isolation of infected persons, vaccination
of household contacts and other close contacts of infected persons (i.e.,
primary contacts), and vaccination of household and other potential contacts
of the primary contacts (i.e., secondary contacts).
The clinic guide will
assist planning for larger-scale, post-event vaccination when exposure circumstances
indicate the need to supplement the ring vaccination approach with broader
protective measures. The clinic guide describes the activities and staffing
needs associated with large-scale smallpox vaccination clinics, including
suggested protocols for vaccine safety monitoring and treatment. The clinic
guide provides an example of a model smallpox clinic and provides samples
of pertinent clinic consent forms and patient information sheets that would
be used at a clinic.
The clinic guide and the
Smallpox Response Plan and Guidelines, Version 3 are available at http://www.cdc.gov/smallpox.
CDC will take additional steps to increase preparedness to respond to a smallpox
exposure of any magnitude, including updates to the Smallpox Response Plan
and Guidelines. Updates on infection control, in-hospital isolation recommendations,
post-event vaccination protocols, and outbreak response strategies are under
way and will be posted on the CDC website.
Pelosi E, Arena V, Bello
M, Cesana P, Lamberti L, Spandonari T, Ropolo R, Sandrucci S, Bisi G.
de Medicina Nucleare, Azienda Ospedaliera San Giovanni Battista, Turin, Italy.
Tumori 2002 May-Jun;88(3):S7-8
AIMS AND BACKGROUND: Peritumoral
injection of 99mTc-labeled colloids for lymphoscintigraphy and radioguided
surgery does not entail any relevant radiation burden to the patients. The
real issue about radiation protection concerns the personnel involved in the
procedure besides the nuclear medicine personnel. The aim of our study was
to evaluate the cumulative doses to personnel involved during the injection
of radiolabeled compounds, under ultrasound or stereotactic guidance and the
radiation burden to the personnel involved in the surgical incision of the
tumor 24 hours after the administration of 99mTc-labeled colloids. METHODS
AND STUDY DESIGN: We performed environmental contamination tests (SMEAR TEST)
and exposure evaluation in the operating room. RESULTS: In the operating room
the removed activity in the analyzed samples was less than 0.5 Bq/g and exposure
to the personnel was less than 6 micro Sv/h. The evaluations made during ultrasound
guidance demonstrated an equivalent and effective dose less than 20 microSv.
CONCLUSIONS: Our results show that during ultrasound or stereotactic administration
of radiolabeled compounds the radiation burden to the personnel involved in
the procedure is virtually negligible. The surgeons too are exposed to a negligible
Jellema P, Bierma-Zeinstra
SM, Van Poppel MN, Bernsen RM, Koes BW.
Department of General
Practice, Erasmus University Rotterdam, The Netherlands. email@example.com
Occup Med (Lond) 2002
The aims of this study
were to assess the compliance of home care workers with low back pain (LBP)
in using a lumbar support, to establish the benefit experienced from the support,
and to determine the predictive factors for that compliance and benefit. Only
home care workers who had LBP at the start of the study or who had experienced
at least two episodes of LBP in the 12 months prior to the study could apply
for participation. The study consisted of two phases. In phase I (the first
week of the study), workers used the lumbar support each working day. In phase
II (the following 6 months), subjects were instructed to use the lumbar support
only on those working days when they experienced LBP. Weekly questionnaires
were used to measure compliance; monthly questionnaires were used to measure
the benefit experienced. Fifty-nine workers participated in the study. Overall,
they scored their perceived benefit from the lumbar support as 7 on a scale
of 0-10, and 61-81% of the workers were compliant. Multiple linear regression
analysis showed that the best predictor for experienced benefit is the degree
of confidence in expected pain reduction due to the lumbar support, measured
after phase I (R(2) = 0.70). Multiple logistic analysis showed that the best
predictor for compliance is the extent to which subjects consider they can
influence their own health status (R(2) = 0.49). Because both the benefit
experienced and the compliance rate were substantial, the use of lumbar supports
by home care workers with LBP seems feasible. However, we cannot recommend
extensive use of lumbar supports in home care workers with LBP based solely
on the results of the present study. First, there is a clear need for a randomized
clinical trial on this topic.
Walker B Jr, Nidiry J.
Inhal Toxicol 2002 Sep;14(9):975-90
Recent cases of nosocomial
poisoning associated with the treatment of patients contaminated with organophosphate
(OP) insecticides and the increasing potential for exposure to these chemicals
elevate into sharper focus the continuing clinical and public health problem
of pesticide poisoning. Despite a number of reports on the multiple aspects
of OPs insecticides and their health effects, the general public and health
services professionals, broadly defined, remain confused and misinformed about
this class of chemicals. In this article we examine sources of exposure and
current knowledge of health effects of OPs. The protection of health care
workers is also discussed.
[Article in French]
Presse Med 2002 Oct 5;31(32):1530;
[Article in Japanese]
Horiike A, Fujita J, Okitsu
H, Bandoh S, Ishii T, Tojo Y, Okada H, Ishida T, Sato K, Yamadori I.
First Department of Internal
Medicine, Kagawa Medical University, Kagawa, Japan.
Nihon Kokyuki Gakkai Zasshi
We report a case of pneumoconiosis
in a dental technician. He was a 33-year-old man who had worked in a dental
clinic as a dental technician for 12 years. In October 1999, he visited to
the National Zentsuji Hospital complaining of progressive cough and sputum
over a three-year period. Although he received medication, his condition did
not improve. He visited the same hospital again on May 8, 2000. His chest
radiographs and CT films showed massive shadows in both upper lung lobes.
Pneumoconiosis was diagnosed from the pathological findings in a lung specimen
obtained by video-assisted thoracic surgery (VATS). There are few reports
of pneumoconiosis of dental technicians diagnosed by VATS.
[Article in French]
Service de dermatologie
Hopital Fournier 54035 Nancy. firstname.lastname@example.org
Rev Prat 2002 Sep 1;52(13):1425-32
are frequent among healthcare workers. Irritant hand dermatitis is more common
than allergic contact dermatitis. It is enhanced by the exposure to irritants:
water, detergents, disinfectants and a history of atopic dermatitis. Natural
rubber latex contained in rubber gloves can induce contact urticaria or generalized
immediate allergic reactions. Contact eczema can be induced by rubber accelerators
such as thiurams, disinfectants (glutaraldehyde, dodecyldimethylammonium).
Nurses can become sensitized to handled drugs (antibiotics, propacetamol...).
These occupational allergies have to be diagnosed, because sensitized nurses
can develop severe generalized cutaneous adverse drug reactions if they are
systemically exposed to the same drug than those that has previously induced
an occupational contact allergy.
Publication Types: Review
PMID: 12385152 [PubMed
- indexed for MEDLINE]
[Article in French]
Fantoni-Quinton S, Frimat
Service de medecine du
travail, pathologie professionnelle Hopital Claude-Huriez 59037 Lille.
Rev Prat 2002 Sep 1;52(13):1451-5
are very frequent with important social and economic implications. Detection
of an occupational factor must be systematic because it may require prevention
and a compensation may be due to the patient. The general practitioner will
be assisted either by the occupational physician or by specialised services
to help the patient to take the necessary administrative steps.
Harakeh S, Sabra N, Kassak
K, Doughan B.
Department of Environmental
Health, Faculty of Health Sciences, American University of Beirut, New York,
NY 10022, USA. email@example.com
Sci Total Environ 2002
The aim of the current
study is to examine the various factors, which contribute to high levels of
mercury (Hg) in the hair of Lebanese dentists. The survey, which was carried
out on ninety-nine dentists in the greater Beirut area, included a structured
questionnaire designed to provide information about the parameters that influenced
their occupational exposure to Hg. These included: precautionary measures,
dental fillings, work habits and lifestyle of the tested dentists. The study
showed that two of the four investigated precautionary measures had a significant
effect on Hg level. The results revealed that, at the 95% confidence levels,
Hg concentration in hair was significantly lower among the dentists who always
used gloves and masks. Multiple regression analysis showed that the use of
masks (P = 0.055) had significant effects on mercury accumulation in hair.
In addition, dentists who saw more than eight patients per day had marginally
higher mercury levels in their hair than those who did not. Since it was shown
that precautionary measures could limit exposure to Hg concentration, then
the use of protective measures needs to be emphasized.
Linda H. Aiken, PhD, RN;
Sean P. Clarke, PhD, RN; Douglas M. Sloane, PhD; Julie Sochalski, PhD, RN;
Jeffrey H. Silber, MD, PhD
Context The worsening
hospital nurse shortage and recent California legislation mandating minimum
hospital patient-to-nurse ratios demand an understanding of how nurse staffing
levels affect patient outcomes and nurse retention in hospital practice.
Objective To determine
the association between the patient-to-nurse ratio and patient mortality,
failure-to-rescue (deaths following complications) among surgical patients,
and factors related to nurse retention.
Design, Setting, and Participants
Cross-sectional analyses of linked data from 10 184 staff nurses surveyed,
232 342 general, orthopedic, and vascular surgery patients discharged from
the hospital between April 1, 1998, and November 30, 1999, and administrative
data from 168 nonfederal adult general hospitals in Pennsylvania.
Main Outcome Measures
Risk-adjusted patient mortality and failure-to-rescue within 30 days of admission,
and nurse-reported job dissatisfaction and job-related burnout.
Results After adjusting
for patient and hospital characteristics (size, teaching status, and technology),
each additional patient per nurse was associated with a 7% (odds ratio [OR],
1.07; 95% confidence interval [CI], 1.03-1.12) increase in the likelihood
of dying within 30 days of admission and a 7% (OR, 1.07; 95% CI, 1.02-1.11)
increase in the odds of failure-to-rescue. After adjusting for nurse and hospital
characteristics, each additional patient per nurse was associated with a 23%
(OR, 1.23; 95% CI, 1.13-1.34) increase in the odds of burnout and a 15% (OR,
1.15; 95% CI, 1.07-1.25) increase in the odds of job dissatisfaction.
Conclusions In hospitals
with high patient-to-nurse ratios, surgical patients experience higher risk-adjusted
30-day mortality and failure-to-rescue rates, and nurses are more likely to
experience burnout and job dissatisfaction.
Evers W, Tomic W, Brouwers
Int J Ment Health Nurs
This study examines relationships
between experienced aggressive behaviour and burnout of staff caring for residents
living in homes for the elderly (n = 551). Burnout was conceptualized as a
three-dimensional syndrome consisting of emotional exhaustion, depersonalization
and reduced personal accomplishment. From the results of the hierarchical
regression analyses it appeared that physical and psychological aggression
and the number of weekly working hours had a significant relationship with
emotional exhaustion of staff. Psychological aggression was found to have
a significant relationship with depersonalization. Neither sex nor age had
a relationship with any of the burnout dimensions. Implications for research
and suggestions for work and training of staff caring for the elderly are
GENEVA (ILO News) - Faced
with a mounting toll of violence afflicting on average one of every two health
workers worldwide, a joint programme of labour, health and public service
organizations today launched a new initiative aimed at helping health professionals
fight fear, assault, humiliation and even homicide where they work.
The joint task force -
comprising the International Labour Office (ILO), the World Health Organization
(WHO), Public Services International (PSI) and the International Council of
Nurses (ICN) - has launched a set of "Framework guidelines for addressing
workplace violence in the health sector" during a meeting at ILO headquarters
The initiative comes in
the face of a mounting problem in hospitals and other health workplaces worldwide,
both in developed and developing countries. Research* shows that nearly 25
per cent of all violent incidents at work occur in the health sector and that
more than 50 per cent of health care workers have experienced such incidents.
"The current knowledge
is only the tip of the iceberg", adds international safety and health
specialist Vittorio di Martino, who has studied violence in the workplace
for the task force. "The enormous cost of violence at work for the individual,
the workplace and the community at large is becoming increasingly apparent."
The study notes that violence
in the health sectors goes well beyond assaults or affronts to the individuals,
threatening the quality of health care as well as productivity and development.
Says di Martino: "The consequences of violence at work in the health
sector have a significant impact on the effectiveness of health systems, especially
in developing countries."
Women are especially vulnerable.
While ambulance staff are reported to be at greatest risk, nurses are three
times more likely on average to experience violence in the workplace than
other occupational groups. Since most health workers are women, the gender
dimension of the problem is evident.
In accordance with the
European Commission, the guidelines define workplace violence as "incidents
where staff are abused, threatened or assaulted in circumstances related to
their work, including commuting to and from work, involving an explicit or
implicit challenge to their safety, well-being or health". Although workplace
violence has become a serious problem in all service sectors, reports* show
that health workers are among those particularly at risk:
In the United States,
health care workers face a 16-times greater risk of violence than other service
workers. More than half of the claims of aggression in the workplace in the
come from the health sector.
In the United Kingdom,
nearly 40 per cent of the National Health Service (NHS) staff reported being
bullied in 1998.
In Australia, 67.2 per
cent of health workers have experienced physical or psychological violence
Widespread violence at
work against health personnel is not limited to the industrialized world.
More than half of the health personnel in Bulgaria (75.8 per cent), South
Africa (61 per cent) and Thailand (54 per cent) and 46.7 per cent of health
workers in Brazil have experienced at least one incident of physical or psychological
violence in 2001.
Research also shows that
psychological violence in the health sector - including verbal abuse, bullying
and mobbing - is more frequent than physical violence and between 40 and 70
per cent of the victims report significant stress symptoms.
Workplace violence affects
all professional groups, genders and work settings in the health sector. The
highest rates of offences, however, were reported by ambulance staff, nurses
and doctors. Large hospitals in suburban, densely populated or high crime
areas, as well as those located in isolated areas, are particularly at risk.
In many countries, reporting
procedures are lacking and perpetrators are not persecuted. Strategies to
combat workplace violence in the health sector still have a long way to go,
starting with raising awareness and building understanding among health personnel
and other parties concerned at all levels.
The guidelines are intended
to support all those responsible for safety in the workplace, be they governments,
employers, workers, trade unions, professional bodies or the general public.
In particular, the guidelines show how health workers can approach the problem
of violence in the health sector while considering all types of intervention
and involving all parties concerned in a coherent, non-discriminatory, culturally
and gender sensitive manner; identify, assess and reduce the risks through
preventive action; and minimize the impact of violence and prevent its recurrence.
The guidelines prioritize
the development of a human-centred workplace culture based on dignity, non-discrimination,
equal opportunity and cooperation, including a clear policy statement on violence
at work from the top management and awareness raising initiatives at all levels.
The ILO is expected to adopt a Code of Practice on Violence and Stress at
Work in Services - A Threat to Productivity and Decent Work in October 2003.
( 23 November )
Henry C. Tong, MD; Geeta
Kandala, MD; Andrew J. Haig, MD; Virginia S. Nelson, MD, MPH; Karen S. J.
Yamakawa, MS; Ki Y. Shin, MD
Arch Pediatr Adolesc Med.
Objectives To evaluate
if physical functioning is different in female caregivers of children with
physical disabilities compared with female caregivers of children with nondisabling
medical illnesses, and to investigate the factors associated with functioning
Patients Ninety consecutive
female caregivers of children presenting to a pediatric physical medicine
and rehabilitation (PM&R) clinic, and 23 presenting to a pediatric endocrine
Main Outcome Measures
The dependent variable measured was physical functioning (physical functioning
subscale of the Short Form-36). Independent variables measured were the average
back pain severity over the last week (100-mm visual analog scale), mood (using
the Center for Epidemiologic Studies–Depression Scale), work status, amount
of lifting at work, caregiver demographics, child demographics, and the physical
functioning ability of the child (measured using the WeeFIM scale).
Results The mean (SD)
physical functioning score of caregivers of children in the pediatric PM&R
clinic was 80.6 (21.9), which was less than the score of 90.2 (17.6) for caregivers
in the pediatric endocrine clinic (mean difference, 9.6; 95% confidence interval,
-0.9 to -18.4). The physical functioning score of 77.7 (22.9) in caregivers
of PM&R clinic children with a WeeFIM scale score of 1 to 4 was significantly
worse than the 90.5 (14.8) in female caregivers of children with a WeeFIM
score of 5 to 7 (mean difference, 12.8; 95% confidence interval, -2.0 to -23.6).
This decrease is associated with the average pain severity, mood, and total
length of time of back pain in the previous 12 months. Regression analysis
shows that pain severity and caregiver mood are significantly related to the
physical functioning status of the caregiver.
functioning is decreased in female caregivers of children with a physical
disability. This decrease is associated with caregiver pain severity and mood.
P. P. Moodley and M. O.
South Africa's inequitable
public health system is mainly delivered by provincial health departments,
and exemplifies the potential and problems of occupational health services
in middle-income countries. The occupational health services for 153 265 employees
in all of South Africa's 370 provincial hospitals were described and compared.
Information was obtained from 303 (82%) hospitals, using a self-completed
questionnaire and telephone interviews. Thirty-two per cent of hospitals had
an occupational health clinic, but 61% of employees worked in hospitals with
a clinic. Occupational health clinics were more likely to be present in larger
hospitals, and were strongly associated with provision of primary care and
chronic disease services to workers. Thirty-nine per cent of hospitals had
a safety officer, 41% had access to an industrial hygienist or environmental
health officer, and 80% had health and safety committees, as required by law.
While occupational health services were more likely in larger hospitals, workforce
size did not explain the marked differences between provinces. The study shows
that substantial occupational health services exist, but that important gaps
persist, even in wealthier provinces and especially in provinces without coherent
occupational health policies.
Intensive Crit Care Nurs
Homerton University Hospital,
London, UK. firstname.lastname@example.org
The purpose of this study
was to discover nurses' views on the function of Health Care Assistants (HCA)
in Intensive Care (ICU). A questionnaire that utilised open-ended questions
was distributed to all registered nurses working on the researchers ICU. Questions
were based on issues including; general views on the utilisation of HCA, the
transfer of aspects of nursing workload, education and training. A response
rate of 96% was achieved. The results indicated strong support for the introduction
of HCA on the researchers ICU but conflicting opinion in regards to the function
they should serve. In light of the results, this study seeks to open the debate
concerning HCA' suitability for employment in the researchers ICU. Recommendations
are also made for practice and further research.
Hosp Health Netw 2002
Infrared technology allows
hospitals to keep track of where their nurses are. Hundreds of hospitals use
such systems--but some nurses say that they violate their privacy.
Publication Types: News
Mullen A, Murray L.
Int J Ment Health Nurs
There are growing concerns
identified in the literature about the lack of quality clinical placements
in mental health for undergraduate nursing students. This study outlines an
innovative student programme, designed and implemented by clinicians, committed
to providing a quality clinical placement for students. The programme was
evaluated by the use of an open-ended questionnaire administered to a sample
of 10 undergraduate nursing students. Results of this evaluation suggested
that the programme was able to provide a positive clinical experience in mental
health for nursing students and is worthy of a more controlled investigation.
Hosp Health Netw 2002
Oct;76(10):44-6, 48, 2
The nurse shortage is
threatening to reach crisis proportions for hospitals around the nation. But
one hospital and two health care systems have virtually eliminated their nurse
vacancy rates through strategies that respect and energize their nursing staffs.
Breeding J, Turner de