农业从业人员肌肉骨骼疾患工效学干预研究进展

肌肉骨骼疾患(MSDs)作为一种慢性非致死性疾病,是农业从业人员中最常见的疾病之一。本文综述了农业生产中能降低从业人员肌肉骨骼疾患的简易低成本工效学干预措施。低成本工效学干预措施主要减少已知危险因素的暴露,包括工程干预、管理干预和个体/行为干预。尽管一些干预措施能在很大程度上改善不良工作姿势并提高生产效率,但仍有一些不足。有效的工效学干预需要对工效学设施的实用性进行深入探讨,并且需要目标群体的积极参与,新技术的应用也应与当地的社会文化、风俗及教育程度相适应。今后应加强肌肉骨骼疾患干预新技术实用性、经济性等方面的研究,并加强发展中国家与发达国家之间的合作。     

Understanding the ergonomic risk for musculoskeletal disorders in the United States agricultural sector

INTRODUCTION: Farming is a very large industry in the United States. Understanding the risks for injuries and more specifically musculoskeletal disorders in this industry poses a challenge for health officials. METHODS: A review was conducted of the existing peer-reviewed publications prior to December 2006 about injuries and musculoskeletal disorders for farmers and farm workers. The aim was to review existing knowledge concerning: (1) the prevalence, types, and causes of farm-related injuries, paying particular attention to musculoskeletal disorders and the special populations within the agricultural sector, and (2) interventions that have been developed to reduce risk factors associated with farm-related injuries. RESULTS: Farmers and farm workers experience high rates of low back, shoulder, and upper extremity disorders. Musculoskeletal disorders may disproportionately affect farm youth and migrant workers due to the types of farm tasks performed. There is an urgent need for improved and validated interventions to reduce exposures and to improve the health of farmers and farm workers. DISCUSSION: Future farm-related musculoskeletal disorder research should emphasize: (1) better identification of exposures for special populations, (2) development of interventions for diverse farm populations, and (3) identification of additional exposures for musculoskeletal disorders. Inadequate understanding of musculoskeletal disorders in farming impedes efforts to prevent this common and important type of occupational injuries on farms.     

The role of social work in free healthcare clinics and student-run clinics

Background: The role of social work in free healthcare clinics and student-run clinics remains an understudied topic. Method: We conducted a literature review of the published studies through four online databases: Google Scholar, Social Work Abstracts, Academic Search Complete, and PsycInfo. Results: The literature review revealed 449 possibly relevant studies, but only nine met the criteria for the final review. Based on these findings, social work is not fully utilized in free healthcare clinics and student-run clinics. Conclusion: Our literature review provides evidence for the need for social work in free healthcare clinics and student-run clinics.     

汽车制造企业工人工效学负荷水平与肌肉骨骼疾患关系研究

目的 研究汽车制造企业工人工效学负荷因素暴露水平及相关因素与肌肉骨骼疾患(MSD)问的关系.方法 选取我国南方3家汽车生产企业,使用快速暴露检查表(QEC)及北欧标准化肌肉骨骼症状分析调查表(NMQ)对1 065名生产工人进行问卷调查,分析其工效学负荷及MSD发生的相关危险因素.结果 本次调查企业的生产工人背部MSD症状的阳性率最高(61.8%).各部位患MSD者工效学负荷评分均高于未患MSD者(P<0.01).男性的工效学负荷水平显著高于女性(JP<0.01).工种间比较,背部负荷评分冲压、焊装(P<0.01)均高于总装,肩/臂部负荷评分焊装高于其他各工种(P<0.01).多因素logistic回归分析中,各部位工效学负荷均为其患MSD的危险因素,工作节奏与工作压力也是其重要的危险因素.结论 本次调查的汽车企业焊装工种工效学负荷相对水平较高,其身体各部位MSD的发生与工效学负荷得分相关,需加以控制.此外,工作节奏与压力因素对工人MSD的患病也有较大影响,需在工效学评价与干预中加以考虑.     

Validation of an asthma questionnaire for use in healthcare workers

Background

Previous studies have described increased occurrence of asthma among healthcare workers, but to our knowledge there are no validated survey questionnaires with which to study this occupational group.

Aims

To develop, validate, and refine a new survey instrument on asthma for use in epidemiological studies of healthcare workers.

Methods

An initial draft questionnaire, designed by a multidisciplinary team, used previously validated questions where possible; the occupational exposure section was developed by updating health services specific chemical lists through hospital walk‐through surveys and review of material safety data sheets. A cross‐sectional validation study was conducted in 118 non‐smoking subjects, who also underwent bronchial challenge testing, an interview with an industrial hygienist, and measurement of specific IgE antibodies to common aeroallergens.

Results

The final version consisted of 43 main questions in four sections. Time to completion of the questionnaire ranged from 13 to 25 minutes. Test–retest reliability of asthma and allergy items ranged from 75% to 94%, and internal consistency for these items was excellent (Cronbach''s α ⩾ 0.86). Against methacholine challenge, an eight item combination of asthma related symptoms had a sensitivity of 71% and specificity of 70%; against a physician diagnosis of asthma, this same combination showed a sensitivity of 79% and specificity of 98%. Agreement between self‐reported exposures and industrial hygienist review was similar to previous studies and only moderate, indicating the need to incorporate more reliable methods of exposure assessment. Against the aerollergen panel, the best combinations of sensitivity and specificity were obtained for a history of allergies to dust, dust mite, and animals.

Conclusions

Initial evaluation of this new questionnaire indicates good validity and reliability, and further field testing and cross‐validation in a larger healthcare worker population is in progress. The need for development of more reliable occupational exposure assessment methods that go beyond self‐report is underscored.     

The usefulness of masks in preventing transient carriage of epidemic methicillin-resistant Staphylococcus aureus by healthcare workers

We assessed the usefulness of wearing masks in preventing epidemic methicillin-resistant Staphylococcus aureus (EMRSA) carriage in nursing and physiotherapy staff on two dedicated EMRSA units. In the first phase of the study, members of staff were screened for EMRSA carriage immediately before and after periods of duty using nose, throat and hand swabs. During the second phase of the study, masks were worn by staff carrying out procedures associated with significant EMRSA exposure and examined for EMRSA as described for the first phase. Both phases were conducted over a period of two months. Forty-eight percent of nursing staff were colonized with EMRSA at some time during the first phase of the study. Wearing masks significantly reduced nasal, throat and hand carriage of EMRSA (P= 0.05). We conclude that the wearing of masks by healthcare workers performing certain activities for EMRSA positive patients may prevent transient colonization and hence may be a useful intervention in the control of EMRSA in the hospital environment.     

Survey of tuberculosis incidents in hospital healthcare workers, England and Wales, 2005

BACKGROUND: Tuberculosis (TB) incidence has increased in England and Wales since 1987, with much of the increase in migrants from high TB incidence countries. The National Health Service increasingly depends on healthcare workers (HCWs) trained abroad, often from areas of high TB incidence. A retrospective survey of TB incidents in hospital-based HCWs was carried out to describe their frequency, distribution and characteristics. METHODS: Reports of HCWs with TB in hospitals were identified among routine surveillance of TB incidents. Additional data on these and reports of further incidents fitting the study definition were obtained by contacting local and regional Health Protection Units. RESULTS: At least 105 incidents of TB in hospital-based HCWs occurred in England and Wales in 2005. Most involved HCWs from high incidence countries, and most cases had pre-employment occupational health screening. We found no evidence of onward transmission within hospitals. CONCLUSIONS: Pre-employment screening for active disease may not be enough to prevent the occurrence of these incidents. A high index of suspicion among HCWs with TB symptoms is needed. Detection of latent infection with interferon gamma release assays, and the use of preventive treatment, should be evaluated.     

Providing healthcare under ISIS: A qualitative analysis of healthcare worker experiences in Mosul,Iraq between June 2014 and June 2017

ABSTRACT

During ISIS occupation of the Northern Iraqi city of Mosul between June 2014 to June 2017, healthcare workers remaining in Mosul continued to provide medical services. Little is currently known about Iraqi healthcare workers’ personal and professional lives in the ISIS healthcare system, and how these individuals adapted. This study sought to explore their experiences during occupation through thematic analysis of qualitative data from twenty interviews conducted immediately after ISIS withdraw from Mosul in August 2017. Participants were sampled from healthcare facilities still in operation after liberation and included healthcare workers of varying disciplines, age and gender. Participants described major changes to their personal and professional lives under ISIS and an extremely limited perceived ability to negotiate the challenges of providing healthcare in the ISIS system. They described terrifying working environments, the strict separation between the sexes, restricted movement, and continuous monitoring by the Al-Hesba morality police. Infractions of ISIS law and subsequent punishment, deaths and kidnappings, changes in personal relationships, poverty and the disrupted schooling of children were also discussed. The importance of protection by supervisors, access to additional money and transportation were highlighted. Understanding these hardships may help support the recovery of health workers experiencing similar situations.

Abbreviations: HCW: Healthcare Worker; PHCCs: Primary Health Care Clinics; ISIS: Islamic State of Iraq and Syria     

The effect of predictive analytics-driven interventions on healthcare utilization

This paper studies a commercial insurer-driven intervention to improve resource allocation. The insurer developed a claims-based algorithm to derive a member-level healthcare utilization risk score. Members with the highest scores were contacted by a care management team tasked with closing gaps in care. The number of members outreached was dictated by resource availability and not by severity, creating a set of arbitrary cutoff points, separating treated and untreated members with very similar predicted risk scores. Using a regression discontinuity approach, we find evidence that predictive analytics-driven interventions directed at high-risk individuals reduced emergency room and specialist visits, yet not hospitalizations.     

Occupational risk of infection by varicella zoster virus in Belgian healthcare workers: a seroprevalence study

OBJECTIVES—To assess the prevalence of varicella zoster virus (VZV) antibodies in Flemish (Belgian) healthcare workers, to investigate the association between seronegativity and selected variables, and to assess the reliability of recall about disease as a predictor of immunity.
METHODS—A seroprevalence study of VZV antibodies (IgG) was conducted among a systematic sample of 4923 employees in various professional groups, employed in 22 hospitals in Flanders and Brussels (Belgium). Information about sex, age, department, job, and years of employment, the country of origin, and history of varicella was obtained. The presence of VZV antibodies was investigated with the enzyme linked immunosorbent assay (ELISA), Enzygnost anti VZV / IgG (Dade Behring, Marburg, Germany). Statistical analysis was performed by calculating prevalences and prevalence ratios (PRs) and their 95% confidence intervals (95% CIs). Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of the recalled history were determined.
RESULTS—The prevalence of VZV seropositivity in Flemish healthcare workers was 98.5% (95% CI 98.1 to 98.8). Seronegativity was significantly associated with age and job, increasing with both older and younger age. The prevalence of seronegative workers was significantly less in nursing staff than non-nursing staff. There was no significant difference for sex and years of employment. The PPV and NPV of recalled history were 98.9% and 3.4%. Sensitivity and specificity were 83% and 38.9%.
CONCLUSION—The prevalence of VZV seropositivity was very high in this sample of Flemish healthcare workers. Because of this low overall susceptibility, VZV infection seems not to be an important occupational risk among healthcare workers in Flanders. The increasing seronegativity above the age of 45 is possibly due to a loss of detectable antibodies. A positive history of varicella was a good predictor of immunity, but a negative history had no value as a predictor of susceptibility in adults.


Keywords: varicella; healthcare workers; occupational risk     

手卫生对医院感染成本效益的影响

目的了解干预前后医务人员手卫生依从率及手术患者医院感染发生率,分析手卫生对医院感染成本效益的影响。方法以2012年12月—2014年6月某院神经外科78名医务人员作为手卫生依从性干预对象,进行颅脑清洁手术的325例患者作为医院感染调查对象,比较干预前后医务人员手卫生依从率、手术患者医院感染发病率、手卫生成本,以及手术患者住院费用等。结果干预前手卫生依从率为35.24%(216/613),干预后为73.75%(486/659);干预前医院感染发病率为31.85%(50/157),干预后为18.45%(31/168),干预前后比较,差异均有统计学意义(χ~2值分别为180.091、7.782,均P0.001)。干预前患者平均住院费用为(89 524.90±38 856.70)元,干预后为(61 401.00±29 237.80)元;干预前患者平均住院日为36.70 d,干预后为26.90 d,差异均有统计学意义(t值分别为3.296、3.511,均P0.01)。结论提高医务人员手卫生依从性,能降低医院感染发病率,减少患者的住院费用,缩短患者住院日。     

A prospective study of computer users: II. Postural risk factors for musculoskeletal symptoms and disorders

BACKGROUND: Despite widespread recommendations regarding posture during computer use, associations between specific postures and musculoskeletal health are not well characterized. METHODS: Six hundred and thirty-two newly hired computer users were followed prospectively to evaluate associations between posture and neck or shoulder (N/S) and hand or arm (H/A) musculoskeletal symptoms and musculoskeletal disorders. Participants' postures were measured at entry and they reported symptoms on weekly diaries. Participants reporting symptoms were examined for specific disorders. Multivariate Cox regression models were used to estimate associations between postural variables and risk of symptoms and disorders, controlling for confounding variables. RESULTS: Keying with an inner elbow angle > 121 degrees, greater downward head tilt, and presence of armrests on the participants chair were associated with lower risk of N/S symptoms or N/S disorders. Keying with elbow height below the height of the "J" key and the presence of a telephone shoulder rest were associated with a greater risk of N/S symptoms or N/S disorders. Horizontal location of the "J" key > 12 cm from the edge of the desk was associated with a lower risk of H/A symptoms and H/A disorders. Use of a keyboard with the "J" key > 3.5 cm above the table surface, key activation force > 48 g, and radial wrist deviation of > 5 degrees while using a mouse was associated with a greater risk of H/A symptoms or H/A disorders. The number of hours keying/week was associated with H/A symptoms and disorders. CONCLUSIONS: The results suggest that the risk of musculoskeletal symptoms and musculoskeletal disorders may be reduced by encouraging specific seated postures.