Perceived physical demands and reported musculoskeletal problems in registered nurses

BACKGROUND: Nursing is physically demanding, and nurses have higher rates of musculoskeletal disorders (MSDs) than most other occupational groups. The physical demands of nursing may lead some nurses to leave the profession, contributing to the shortage of registered nurses in many workplaces that is a major concern today. As a first step toward reducing MSDs and their consequences, this study was designed to examine the relationship between perceived physical demands and reported neck, shoulder, and back MSDs in nurses. METHODS: Data were collected anonymously from 1163 randomly selected working nurses (74% response rate) using a cross-sectional survey. The 12-item survey scale (internal reliability coefficient=0.89), rated perceived physical demands such as force, awkward postures, and heavy lifting. Nurses with a presumed MSD case reported relevant past-year symptoms in the neck, shoulder, and/or back lasting >or=1 weeks, or at least monthly, with moderate or more pain, on average. RESULTS: Moderate and high perceived physical demands were significantly associated with reported neck, shoulder, and back MSD cases, even after adjustments for demographic and lifestyle-related covariates. Adjusted odds ratios for highly demanding work (vs low) ranged from 4.98 to 6.13 depending on body site. When analyses were restricted to staff nurses only, the odds ranged from 9.05 to 11.99. CONCLUSIONS: Perceived physical demands are associated with reported MSD in registered nurses, and the association is stronger in staff nurses.     

母亲抑郁对6、14月龄婴儿气质评估的影响

目的:探讨母亲抑郁倾向对母亲报告的婴儿气质是否有影响。方法:采用母亲问卷报告让269位母亲在婴儿6、14个月时报告婴儿气质及其自身的抑郁程度。结果:婴儿从6～14个月气质具有稳定性,6个月时高、中、低抑郁型的母亲报告的婴儿活动性水平差异有统计学意义,但是14个月时没有出现。6、14个月时高、中、低抑郁性母亲均报告的婴儿受限后水平差异有统计学意义。结论:母亲抑郁倾向对婴儿气质确实存在影响,高抑郁性母亲报告的婴儿气质存在偏差。     

Resilience and depression: perspectives from primary care

Resilience refers to the capacity for successful adaptation or change in the face of adversity. This concept has rarely been applied to the study of distress and depression. We propose two key elements of resilience - ordinary magic and personal medicine - which enable people to survive and flourish despite current experience of emotional distress. We investigate the extent to which these elements are considered important by a sample of 100 people, drawn from a longitudinal study of the management of depression in primary care in Victoria, Australia. We also assess how respondents rate personal resilience in comparison with help received from professional sources. Our data are obtained from semi-structured telephone interviews, and analysed inductively through refinement of our theoretical framework. We find substantial evidence of resilience both in terms of ordinary magic - drawing on existing social support and affectional bonds; and in terms of personal medicine - building on personal strengths and expanding positive emotions. There is a strong preference for personal over professional approaches to dealing with mental health problems. We conclude that personal resilience is important in the minds of our respondents, and that these elements should be actively considered in future research involving people with experience of mental health problems.     

Neuroendocrine reactivity and recovery from work with different physical and mental demands

OBJECTIVES: The purpose of this study was to examine the extent to which the type or nature (physical, mental or mixed mental and physical) of work and work characteristics is related to the course of neuroendocrine reactivity and recovery from work. METHODS: Neuroendocrine reactivity and recovery were studied by measuring the urinary excretion of adrenaline, noradrenaline, and cortisol during and after 3 workdays, 1 consecutive day off, and a baseline day. The assessment was made in 3 groups of Dutch male workers (N=60) who differed in the nature (mental, physical, and combined mental and physical demands) of their work. Multilevel analyses were performed to fit linear mixed-effects models for each hormone. RESULTS: Main or interaction effects with time of day were found between the workers in combined mental and physical work and the 2 other groups of workers for cortisol, adrenaline, and noradrenaline excretion. In addition, the baseline levels of the 3 hormones were higher in the workers with combined mental and physical work when compared with the other 2 groups. The excretion rates during the workdays were higher than those on the day off, but a trend towards mobilizing less activity was found from the 1st to the 3rd workday. Job demands were negatively related to cortisol excretion. Job control and social demands at work did not affect the excretion rates of the hormones. CONCLUSIONS: Unfavorable effects on cortisol and adrenaline reactivity or recovery was found for workers with combined mental and physical demands when compared with workers doing mainly mental or mainly physical work. The results of the present study are in accordance with the cognitive activation theory and the allostatic load model.     

Changes in health-related quality of life from 6 months to 2 years after discharge from intensive care

Background  

Intensive care patients have, both before and after the ICU stay, a health-related quality of life (HRQOL) that differs from that of the normal population. Studies have described changes in HRQOL in the period from before the ICU stay and up to 12 months after. The aim of this study was to investigate possible longitudinal changes in HRQOL in adult patients (>18 years) from 6 months to 2 years after discharge from a general, mixed intensive care unit (ICU) in a university hospital.     

The testing effect on skills learning might last 6 months

In a recent study we found that testing as a final activity in a skills course increases the learning outcome compared to spending an equal amount of time practicing. Whether this testing effect measured as skills performance can be demonstrated on long-term basis is not known. The research question was: does testing as a final activity in a cardio-pulmonary resuscitation (CPR) skills course increase learning outcome when assessed after half a year, compared to spending an equal amount of time practicing? The study was an assessor-blinded randomised controlled trial. A convenient sample of 7th semester medical students attending a mandatory CPR course was randomised to intervention course or control course. Participants were taught in small groups. The intervention course included 3.5 h skills training plus 30 min of skills testing. The practice-only control course lasted 4 h. Both groups were invited to a retention assessment of CPR skills half a year later. Participants included 89/180 (50%) of those invited to participate in the study. Mean performance score was 75.9 (SD 11.0) in the intervention group (N = 48) and 70.3 (SD 17.1) in the control group, effect size 0.4. The difference between groups was not statistically significant, P = 0.06. This study suggests that testing as a final activity in a CPR skills course might have an effect on long-term learning outcome compared to spending an equal amount of time practicing the skills. Although this difference was not statistically significant, the identified effect size of 0.4 can have important clinical and educational implications.     

Recovery from childbirth: Looking back 6 months after delivery

Women's perceptions of their recovery from childbirth were investigated by open‐ended interviews of 96 mothers of healthy, full‐term infants 6 months after delivery. Data included factors affecting physical, mental, and emotional recovery; sources of help and hindrance; ideas of what each woman would do differently after the delivery of another child; and overall evaluation of how the months after delivery compared with expectations. Content analysis of the data revealed that 25% of the women did not feel physically recovered from childbirth at 6 months postpartum. Husbands and other family members were major sources of help. Prolonged labor and cesarean delivery were the major hindrances to recovery. More household and child‐care help was desired after delivery of another child. Almost half of the women found the first 6 months after delivery more difficult than anticipated. The findings suggest that pregnant women need more information about lifestyle adjustments after childbirth.     

Health-related quality of life before planned admission to intensive care: memory over three and six months

Background  

The validity of Health-Related Quality of Life (HRQOL) recalled by ICU admitted patients have not been published. The aim of this study was to compare the baseline HRQOL measured before surgery and ICU admission with that recalled at 3 and 6 months in a population of patients with planned ICU admission after surgery.     

Evaluation from population registry data of health care expenditure during the 6 months after cancer diagnosis

It is currently estimated in France, that the cost of cancer has risen to $3.8 billion, with an annual growth of 5-10%. This represents approximately 6% of all health expenditure. The data from the Registry of Tumors in the Doubs region have enabled us to make an evaluation of health expenditure, reimbursed by the French Securite Sociale (S.S.), and its distribution in relation to different activities (diagnosis, type of treatment, follow-up, transport), according to cancer site. In 1984, the average cost per patient within the first 6 months of the illness was evaluated at $4,000. The results show major differences for the cancer sites, care facilities and budget items. Diagnosis assessment represents 27% of all expenditure, surgery 37%, radiotherapy, chemotherapy and transport, 11% each. All kinds of expenses are fully reimbursed by the French S.S. and transportation, which at the beginning used to avoid hospitalization, is now used as a comfort system and represents a high cost to the S.S. The different costs for the same illness between private, general public and university hospitals do not reflect a difference in care, but rather different systems of calculating and functioning. Till now there has not been any logical evaluation of care in the French health system.     

体育锻炼对孕期抑郁治疗效果的Meta分析

目的 抑郁已经成为威胁心理健康的重要疾病,孕期抑郁会对孕妇、胎儿及新生儿产生不良影响,适宜的锻炼干预是改善孕期抑郁的重要手段,而明确更加合理的锻炼干预方案,对治疗孕期抑郁具有重要作用。采用Meta分析法,探讨锻炼干预对孕期抑郁的影响,并进一步分析可能产生较大干预效应的锻炼方案,以期为今后该领域的锻炼干预研究及临床护理提供参考。方法 通过 PubMed、EMBase、The Cochrane Library、Web of Science、中国知网（CNKI）、中国生物医学文献数据库（CBM）等数据库,检索有关孕期锻炼对抑郁影响的相关文献,采用Cochrane偏倚风险评估工具对纳入的研究进行方法学质量评估并采用改良Jadad进行评分,采用Review Manager 5.4软件对文献数据进行统计学分析。结果 共纳入13篇文献,总样本量为1256例。Meta分析结果显示:锻炼对孕期抑郁呈大效应量干预效果〔SMD=-0.37,95%CI（-0.49,-0.26）,P＜0.00001〕,具有统计学意义。亚组分析结果显示,孕期锻炼开始节点13~27周的干预效果优于孕期28~40、＜12周;≥3次/周的干预效果优于＜3次/周;30~60min/次的干预效果优于＞60min、30min/次;中等强度锻炼的干预效果优于低强度锻炼;8~12周锻炼周期的干预效果优于＞12周、＜8周;锻炼内容对孕期抑郁治疗的干预效果为有氧结合抗阻、瑜伽等。结论 孕期体育锻炼对孕期抑郁治疗有效,不同锻炼内容、强度、频率、周期、开始干预时间节点、单次锻炼时长的锻炼方案干预均有效,且孕期第13~27周开始进行≥3次/周、30~60min/次、8~12周中等强度的体育锻炼方案对孕期抑郁治疗效果更好。     

A comparison of physical activity in Gambian and UK children aged 6-18 months

The activity patterns of 81 Gambian and 53 UK children aged six, 12 or 18 months were compared by means of an activity diary technique. Major differences between communities were observed in the duration of play (2-3 times longer in UK compared to Gambian children) and in the duration of vigorous activities such as crawling, walking and running (2-4 times longer duration in the UK compared to the The Gambia). To investigate whether the lower activity of Gambian children could be explained by differences in nutritional or health status, subgroups of Gambian children were compared. Only small differences in activity pattern were found between Gambian children above and below 80% weight for age and between Gambian children who were or were not diagnosed ill within 10 days of study, suggesting that other factors (e.g. socio-cultural differences or the absence of conventional toys) may explain the lower activity of Gambian compared to UK children.     

6~48月龄儿童睡眠问题与喂养关系的研究

【目的】 了解6~48月龄儿童睡眠问题的现状,探索儿童喂养可能对睡眠产生的影响。 【方法】 研究采用《儿童睡眠状况调查问卷》对6~48月龄儿童家长进行调查,并按照国际睡眠障碍分类作为儿童睡眠问题的诊断标准。 【结果】 6~48月龄儿童睡眠问题发生率为57.8%;发生率随年龄升高而呈下降趋势;未断母乳、未断夜奶、未添加辅食肉和鱼虾及睡前饮水量较多的儿童睡眠问题的发生率均高于没有这些因素的儿童,差异具有统计学意义(P<0.05)。 【结论】 儿童睡眠问题的发生率较高,且与喂养因素有关,改变不良的喂养行为可以改善儿童的睡眠状况。     

0～6个月足月儿和早产儿闪光视觉诱发电位研究

【目的】研究足月儿和早产儿的闪光视觉诱发电位(flash visual evoked potentials,FVEP)特点及临床应用。【方法】应用重庆康华公司的眼多功能检查仪对91名婴儿(足月儿61名,早产儿30名)进行FVEP检测。【结果】获得足月儿和早产儿FVEP波的潜伏期和振幅正常值,及其随月龄的改变而改变的趋势。足月儿0~2、2~4、4~6个月组足月儿P1波潜伏期均值分别为181.77、153.451、32.44 ms,早产儿为213.25、184.22、166.47 ms。组间潜伏期值差异有显著性(P<0.05);比较了早产儿与足月儿FVEP各波潜伏期值的差异及矫正月龄后各波潜伏期值差异,足月儿和早产儿的主波P1出波率相对其它波稳定,且早产儿P1波的潜伏期较足月儿延长,矫正月龄后早产儿的P1波潜伏期与足月儿差异无显著性。【结论】以FVEP波的主波P1潜伏期值为参考值对小婴儿的视功能检查具有可行性;在为早产儿作视功能检查时,建议检查矫正月龄后的潜伏期值是否在正常值范围内。     

Emotional and physical demands on caregivers in home care to the elderly in Switzerland and their relationship to nursing home admission

BACKGROUND: Planning the home care of growing numbers of old, dependent people must include the caregivers' burden. METHODS: A convenience sample of 129 caregivers of elderly patients with multiple diagnoses was interviewed about the caregiving context, burden, caregivers' tolerance of patients' troublesome behaviours and physical symptoms, mutuality and feelings of closeness between caregiver and patient. Continued maintenance of home care was assessed by a follow-up telephone call. RESULTS: Caregivers were mainly spouses (67%) and female (73%), and the mean duration of care was 5.5 years. In five activities of daily living (ADL) 50-69% of the patients needed full help. Caregivers reported predominantly negative effects of caregiving on their physical and mental health, rest and sleep, leisure time and social life, problems with patients' symptoms and behaviours and little or no conversing (51%) or exchanging feelings with patients (71%). PREDICTIVE MODELS: Contributors to variance were for burden (35%), impact of care on caregivers' mental health, social relations and leisure time, patients' gender, accumulation of patients' symptoms and behaviours; for caregivers' tolerance toward patients' symptoms and behaviours (17%) caregivers' physical health, patients' level of confusion, feelings of mutuality; for mutuality (22%) and for closeness (19%) caregivers' mental health, patients' accumulation of symptoms and behaviours. Within 23 months 19% of the patients had been institutionalized. Factors giving a higher likelihood of institutionalization were: being male, caregiver was not a partner, and less closeness between caregiver and patient. CONCLUSION: Caregiving of older persons has bio-psychosocial ramifications for caregivers. Closeness between caregiver and patient seems to be a key factor in determination of the long-term outcome.     

Cancer prevention in primary care: predictors of patient counseling across four risk behaviors over 24 months

OBJECTIVE: Rates of preventive counseling remain below national guidelines. We explored physician and patient predictors of preventive counseling across multiple cancer risk behaviors in at-risk primary care patients. METHODS: We surveyed 3557 patients, with at least one of four cancer risk behaviors: smoking, diet, sun exposure, and/or mammography screening, at baseline and 24 months. Patients reported receipt of 4A's (Ask, Advise, Assist, Arrange follow-up); responses were weighted and combined to reflect more thorough counseling (Ask=1, Advise=2, Assist=3, Arrange=4, score range 0-10) for each target behavior. A series of linear-regression models, controlling for office clustering, examined patient, physician and other situational predictors at 24 months. RESULTS: Risk behavior topics were brought up more often for mammography (90%) and smoking (79%) than diet (56%) and sun protection (30%). Assisting and Arranging follow-up were reported at low frequencies across all behaviors. More thorough counseling for all behaviors was associated with multiple visits and higher satisfaction with care. Prior counseling predicted further counseling on all behaviors except smoking, which was already at high levels. Other predictors varied by risk behavior. CONCLUSIONS: More thorough risk behavior counseling can be delivered opportunistically across multiple visits; doing so is associated with more satisfaction with care.     

Fibromyalgia, cognitive problems and independence: physical activity may be useful in home health care

Home health care providers often deal with older clients who have cognitive deficits. Cognitive problems have a negative impact on independence. Certain chronic pain conditions present with cognitive dysfunction as a co-morbidity. Fibromyalgia syndrome is one such condition. Home health care providers need to know that mild-moderate exercise may positively affect fibromyalgia-related cognitive deficits at very low cost. All of the above is discussed in this paper along with advice concerning the provision of exercise for older, home bound people.     

西安市≤6月龄婴儿体格发育状况及营养状态调查

目的 调查西安市≤6月龄婴儿体格发育状况及营养状态,分析相关的影响因素。方法 采用方便抽样方法随机抽取西安市10个社区或村（5个属于城镇街道办事处,5个属于村镇政府）,在每个社区或村随机选择1家社区卫生服务中心,将2021年6—8月在选中的社区卫生服务中心进行免疫规划疫苗接种的≤6月龄婴儿作为研究对象,婴儿进行体格检查（身长及体重）及血红蛋白水平检测,并对婴儿母亲进行问卷调查。采用描述性分析方法对婴儿营养不良情况进行分析,并采用单、多因素分析方法对婴儿营养不良影响因素进行分析。结果 共纳入11 714名婴儿参与本研究,男婴5 951人,占50.80%,女婴5 763人,占49.20%。≤3月龄占45.65%,4~6月龄占54.35%。共有1 972例≤6月龄婴儿检出为营养不良,营养不良发生率为16.83%。其中生长迟缓的发生率为1.15%,体重不足的发生率为0.96%,消瘦的发生率为1.47%,贫血发生率为14.90%。多因素Logistic回归分析结果显示,喂养情况（部分母乳喂养OR=1.440,人工喂养OR=1.523）、户籍所在地（OR=2.396）、添加辅食类别数量>2种（OR=1.690）、摄入蛋黄（OR=1.657）、摄入水果（OR=1.355）为≤6月龄婴儿营养状况的影响因素。结论 西安市6月龄及以下婴儿营养不良发生风险较高,贫血为主要的营养不良原因。户籍所在地、喂养方式、添加辅食类别数量、摄入蛋黄及水果是6月龄及以下婴儿营养状况的影响因素,可给予针对性的干预。