Low back pain among care workers working at newly-built nursing homes for the aged.

The aim of this study was to investigate the association between severe low back pain (LBP) and work load for care workers (CWs) who were working at newly-built special nursing homes, because it has long been known that LBP is very common among CWs, and we consider that measures to reduce serious LBP should be the top priority. A total of 258 questionnaires were distributed to all CWs employed at 7 nursing homes. There were 214 replies, a response rate of 82.9%. The average age of respondents was 28.8 years old. A total of 212 (59 males and 153 females) completed questionnaires were analyzed. The results of factor analysis were based on 22 original questions about physical and mental care work load. Sixteen questions and 5 subscales were explored. Factor 1 was characteristics and ADL of care receivers; Factor 2, violence by care receivers; Factor 3, communication with staff at workplace; Factor 4, problems with work environment; and Factor 5, communication with care receivers. Severe LBP was defined as a subject who had always suffered from LBP in the last one month. Multiple logistic regression analysis was performed to estimate the relationship of severe LBP and care work load. Adjustments were made for sex and job tenure. In Factor 1, "characteristics and ADL of care receivers", heavy weight showed significant association, with adjusted Odds Ratios of 6.63 (95%CI: 1.71-25.75). Therefore, to prevent LBP of CWs, it is necessary to make staff assignments and to provide assistive devices based on careful considerations of the characteristics and ADL of care receivers.     

养老机构养老护理员职业认同现状及影响因素分析

目的 探讨养老机构养老护理员职业认同现状及其影响因素,为提升养老护理员职业认同水平提供参考依据。方法 采用整群随机抽样法,于2020年9—12月在遵义市城区内的95所养老机构中随机抽取24所,对24所养老机构中符合纳入标准的所有养老护理员采用一般情况调查表、养老护理员职业认同量表、人文关怀能力评价量表进行调查,本次调查共发放问卷351份;应用SPSS 21.0进行数据分析,其中一般情况采用描述性统计分析,职业认同的影响因素采用单因素分析、多元线性逐步回归等方法进行分析。结果 养老护理员职业认同平均得分为（104.95±18.39）分,多元线性回归分析结果显示:养老护理员职业认同影响因素有年龄（t=-2.398,P=0.017）、月收入（t=3.695,P＜0.001）、文化程度（t=2.544,P=0.011）、职业技能证书（t=2.072,P=0.039）、培训机会（t=4.704,P＜0.001）、工作时长（t=-4.254,P＜0.001）、照护老人数量（t=-3.336,P=0.025）、家庭支持情况（t=4.608,P＜0.001）、人文关怀能力（t=9.576,P＜0.001）。结论 养老护理员职业认同处于中等水平,建议有关部门针对以上影响因素提出整改措施,提高养老护理员职业认同水平,促进养老机构护理队伍的建设。     

Evidence-based care for low back pain in workers eligible for compensation

BACKGROUND: Although guidelines for the management of low back pain have been promoted, few studies have assessed their effectiveness. One previous study did not include patients with workers' compensation claims. AIM: To assess the efficacy of evidence-based care for acute low back pain in patients eligible for workers' compensation. METHODS: In a prospective audit, workers in a health service who presented with acute low back pain were offered the option of usual care from their general practitioner or care provided by a staff specialist who practiced according to evidence-based guidelines. Outcomes were measured in terms of return to normal duties, time off work, recurrence of pain or persistence of pain. RESULTS: Evidence-based care was accepted by 65% of injured workers. Compared with those who elected usual care, these workers had less time off work, spent less time on modified duties and had fewer recurrences. A significantly greater proportion (70%) resumed normal duties immediately, and fewer developed chronic pain, than those managed under usual care. Three types of patients were identified: those who complied readily with evidence-based care, those who initially expressed firm beliefs about how they should be managed and those with occupational psychosocial factors. CONCLUSIONS: Evidence-based care can be successful in retaining patients at work, reducing time off work or on modified duties and reducing recurrences and chronicity. The gains are achieved by conscientiously talking to the patients, and not by any particular or special passive interventions.     

Criteria for the management of low back pain in health care workers

Low back pain represents one of the most frequent health problems in several working populations and is an important problem for occupation health doctors. In fact, these professionals are often required to face with the specific management of this condition, also by participating with other professionals into the implementation of organizational and structural measures. This contribute describes a variety of interventions aimed at treating the syndrome and recovering the working ability of the patient-worker, including the initial clinical evaluation, the assessment of the casual relationship between work and the syndrome, the treatment, the formulation of proposals to modify the worker's physical and working activity, the ongoing heath surveillance and a more in-depth clinical and instrumental evaluation, including surgical treatment.     

Feasibility of lumbar supports for home care workers with low back pain

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.     

Load on the low back of teachers in nursery schools

In order to evaluate the load on the low back of teachers in nursery schools, basic activity, working posture, child-lifting, and desk-lifting were analyzed for eight nursery teachers using video recording. The trunk inclination angle (TIA) was also measured continuously during full workshifts for 20 nursery teachers using an inclination monitor. The nursery teachers in the 0–1 (year) age class more often adopted low working postures, sitting on the floor and kneeling, while teachers in the 4–5 age class more frequently adopted high working postures, standing and sitting on a chair. The mean of TIA among all subjects was 20°. The time spent at a TIA of more than 20° represented 43% of the workshift. The mean and time distribution of TIA did not differ between the age classes. The frequency of trunk-lifting from severe bending forward (TIA > 45°) was 86 times/hour on average. The frequency of trunk-lifting was highest in the 0–1 age class. The number of times of child-lifting was 46 in the 0–1 age class, while it was 1 in the 4–5 age class.     

A survey of body temperatures in the elderly and the thermal environment in nursing homes]

In order to understand the relation between body temperatures and activities in the elderly, sublingual temperatures and activities of daily living (ADL) of 92 elderly people living in nursing homes were measured in the winter of 1989 and 1990. Thermal conditions in the three nursing homes were also measured simultaneously. In two nursing homes, where most of the people of low ADL lived, room temperatures were usually kept above 20 degrees C during most of the day, while in the remaining home, where many of the people of high ADL lived, room temperatures in the morning decreased to 8 degrees C. In spite of the better thermal conditions, mean sublingual temperatures, measured in the morning, of the low ADL group were significantly lower than that of middle and the high ADL groups. Moreover, the prevalence of low body temperatures (< 35.5 degrees C) was higher in the low ADL group than in the other two groups. From these results it appears that investigations of the living environment for older people should be widened.     

Subjective pain and tenderness in low back among care workers in relation to work load and daily life]

Five hundred and fifty-two care-workers aged 20 to 60 years, who worked at six custodial-care homes, were examined to clarify the relationship between subjective pain and tenderness in the low back, together with the factors affecting occupational low back pain. Subjects who were diagnosed as having tenderness in the low back by one medical practitioner at the time of health examinations, and those who reported the presence of low back pain in self-rating questionnaires were defined as those with "objective" and "subjective" low back pain, respectively. Complaints concerning workloads and daily life, as well as musculoskeletal and systemic symptoms, were inquired of in the self-rating questionnaires; the former complaints were compiled into four factors representing "environmental load at work," "physical load at work," "mental load at work," and "daily life" by the factor analysis. The corresponding rates in subjective and objective low back pains were 67.0% in 188 male care workers and 70.9% in 364 female care workers. In males and females, "physical load at work" was positively related to subjective low back pain (P < 0.05) with the use of the multiple logistic regression analysis including all the causal and confounding factors. Musculoskeletal symptoms in females were also positively related to subjective and objective low back pain (P < 0.05). These data suggest that subjective low back pain clearly reflects the problem of occupational low back pain as a whole, and that low back pain is mainly related to the physical load at work in care workers.     

Mealtimes in nursing homes: striving for person-centered care

Malnutrition is a common and serious problem in nursing homes. Dietary strategies need to be augmented by person-centered mealtime care practices to address this complex issue. This review will focus on literature from the past two decades on mealtime experiences and feeding assistance in nursing homes. The purpose is to examine how mealtime care practices can be made more person-centered. It will first look at several issues that appear to underlie quality of care at mealtimes. Then four themes or elements related to person-centered care principles that emerge within the mealtime literature will be considered: providing choices and preferences, supporting independence, showing respect, and promoting social interactions. A few examples of multifaceted mealtime interventions that illustrate person-centered approaches will be described. Finally, ways to support nursing home staff to provide person-centered mealtime care will be discussed. Education and training interventions for direct care workers should be developed and evaluated to improve implementation of person-centered mealtime care practices. Appropriate staffing levels and supervision are also needed to support staff, and this may require creative solutions in the face of current constraints in health care.     

Effectiveness of intervention for low back pain in female caregivers in nursing homes: a pilot trial based on multicenter randomization

Objectives  

Although the importance of stretching exercise for pain-relieving and patient education is well documented for chronic lumbago patients, it is uncertain how effective on-the-job training (OJT) is for female caregivers in nursing homes. In the present pilot trial based on multicenter randomization, we evaluated the intervention effect of a lecture and stretching exercise on caregivers in nursing homes.     

Low back load and satisfaction rating of caregivers & care receivers in bathing assistance given in a nursing home for the elderly practicing individual care]

Since the public nursing care insurance system was enacted by the Japanese government, a transition from conventional group treatment to the individual care is required. In Japanese nursing homes for the elderly, bathing assistance methods have shifted from use of traditional mechanical bathtubs or a big bathtub to methods using small homestyle bathtubs, known as "individual bathing assistance". A study on the work load of caregivers with individual bathing assistance has never been conducted. Therefore, in a nursing home for the elderly practicing the individual bathing assistance method, we explored low back load using surface electromyography and trunk inclination angle measurement. Moreover, subjective evaluations by not only the caregivers but also the care receivers were investigated. The individual bathing assistance time per person was about 35 min. When caregiver used the mechanical lift equipment to assist getting into and out of the bathtub, trunk inclination angle and muscle load were lower than with manual handling. Mechanical lift equipment had the advantage of reducing low back load. When caregivers gave assistance with dressing and ablution of the lower limbs, and in setting wheelchair footrests, trunk inclination angle and muscle load showed high values. The satisfaction rating of using the mechanical lift equipment showed the best score, and ratings of perceived exertion were about the same. Thus, the importance of safe and comfortable care for both caregivers and care receivers should be stressed to make effective use of assistance products and care equipment.     

装饰板加工工人腰背痛病因初探

目的探讨装饰板加工工人腰背痛发病情况与工人劳动操作中不良生产条件的关系。方法采用作业场所工效学分析和问卷调查方法对某装饰板加工企业进行了不良工效学因素和工人腰背痛症状的调查。结果装饰板加工工人存在的不良工效学因素主要有操作台面较低、工作姿势和动作不良、劳动时间过长等。选板、贴面和修补工种工人腰背痛主诉分别为72．2％、56．8％和100．0％，且与工人操作台面高低和弯腰持续的时间长短、弯腰的频率和幅度大小有关。结论操作台面过低，工人弯腰时间较长与腰背痛高发有一定关系。     

Cause of death in nursing homes]

Data from the Verpleeghuis Informatie Systeem (Nursing Home Information System, SIVIS) of the Stichting Informatiecentrum Gezondheidszorg (Foundation Information Centre Public Health, SIG) unlike data from the Central Bureau voor de Statistiek (Central Statistics Office, CBS) can afford insight into the primary causes of death of patients in Dutch nursing homes. We studied the question whether the causes of death of patients in somatic and psychogeriatric care differed and whether in these groups there was difference between those decreased within and after six months. Also, using the death certificates issued for the 29 patients deceased in nursing home De Bieslandhof in the first quarter of 1991, a comparison was made of reporting to the SIG and to the CBS. In 1989, data on 82.5% of the nursing home patients were registered in the SIVIS. Irrespective of the interval between admission and death and the nature of the multidisciplinary care (somatic or psychogeriatric), pneumonia was the cause of death most frequently stated (16%). Of the somatic patients decreased within six months the cause of death was mostly a malignancy. The psychogeriatric patients mostly died due to dehydration and cachexia. However, uncertainties in establishing the primary cause of death and registration errors are not made sufficiently clear in the SIVIS registration. The reporting to SIG and CBS does not always tally.