Self-reported musculoskeletal disorders among visiting and office home care workers

This paper examines the associations between self-reported musculoskeletal disorders (MSDs) and work factors and injuries among home care workers. Based on 99 focus group participants and 892 survey respondents, results show a high level of MSDs among both visiting and office home care workers. While visiting home care workers tend to feel pain in the back, office workers tend to report pain in the neck and shoulder. Hazards in clients' homes, injuries moving clients and stress are associated with self-reported MSDs for visiting home care workers. Repetitive tasks and stress are associated with self-reported MSDs for office home care workers. Age and months in the profession have no affect on self-reported MSDs.     

Work organization and musculoskeletal injuries among a cohort of health care workers

OBJECTIVES: This study investigated the relationship between work-organization factors (job control, job demands, and workload measures) and the risk of lower-body musculoskeletal injury among health care workers. METHODS: A four-year, retrospective cohort study of 3769 health care workers was carried out in one acute care hospital in the Canadian province of British Columbia. A job-exposure matrix was constructed for the work-organization factors from survey and administrative data and assigned to workers on the basis of their occupation and department of employment. Musculoskeletal injuries resulting in workers' compensation claims were ascertained from the injury database of the hospital's Occupational Health and Safety Department. RESULTS: In the final Poisson models adjusted for demographic and biomechanical factors, an increased risk for compensated musculoskeletal injuries of the lower back and lower limb was related to low job control [relative risk (RR) 1.64, 95% confidence interval (95% CI) 1.08-2.49] and workload defined by working during periods of high absenteeism within a department (RR 2.10, 95% CI 1.61-2.98). The risk also increased with more biomechanical demands in an occupation and with a recent previous injury. CONCLUSIONS: The results indicate that work-organization characteristics (job control and workload) were associated with an increased risk of musculoskeletal injuries resulting in a compensation claim. These associations remained after the effect of demographic and biomechanical factors was taken into consideration. The association with workload measured by departmental levels of absenteeism should be explored further in future studies as reverse causality (musculoskeletal symptoms resulting in absenteeism) could not be fully ruled out in the current study.     

医务人员针刺伤的危害、预防与管理

正针刺伤是指由头皮针、注射器针头、静脉导管、采血针或皮下注射针头等锐器导致的皮肤损伤~([1]),针刺伤可引起血源性病原体感染,导致血源性疾病的传播。针刺伤对医务人员造成的伤害日益引起重视,据美国职业暴露预防网统计报道,2008年美国99所医院共发生针刺伤3 126例,平均每100张     

Association between perceived inadequate staffing and musculoskeletal pain among hospital patient care workers

Objective

To examine association between perceived inadequate staffing and musculoskeletal pain and to evaluate the role of work-related psychosocial and physical work factors in the association among hospital patient care workers.

Methods

A cross-sectional study was conducted among 1,572 patient care workers in two academic hospitals. Perceived inadequate staffing was measured using the “staffing adequacy subscale” of Nursing Work Index, which is a continuous scale that averages estimates of staffing adequacy by workers in the same units. Musculoskeletal pain (i.e., neck/shoulder, arm, low back, lower extremity, any musculoskeletal pain, and the number of area in pain) in the past 3 months was assessed using a self-reported Nordic questionnaire. Multilevel logistic regression was applied to examine associations between perceived inadequate staffing and musculoskeletal pain, considering clustering among the workers in the same units.

Results

We found significant associations of perceived inadequate staffing with back pain (OR 1.50, 95 % CI 1.06, 2.14) and the number of body area in pain (OR 1.42, 95 % CI 1.01, 2.00) after adjusting for confounders including work characteristics (job title, having a second job or not, day shift or not, and worked hours per week). When we additionally adjusted for physical work factors (i.e., use of a lifting device, and the amount of the time for each of five physical activities on the job), only the association between perceived inadequate staffing and back pain remained significant (OR 1.50, 95 % CI 1.03, 2.19), whereas none of the associations was significant for all of musculoskeletal pains including back pain (OR 0.96, 95 % CI 0.66, 1.41) when we additionally adjusted for work-related psychosocial factors (i.e., job demands, job control, supervisor support, and co-worker support) instead of physical work factors.

Conclusions

Perceived inadequate staffing may be associated with higher prevalence of back pain, and work-related psychosocial factor may play an important role in the potential pathway linking staffing level to back pain among hospital workers.     

Work-related injury among direct care occupations in British Columbia, Canada

Objectives

To examine how injury rates and injury types differ across direct care occupations in relation to the healthcare settings in British Columbia, Canada.

Methods

Data were derived from a standardised operational database in three BC health regions. Injury rates were defined as the number of injuries per 100 full‐time equivalent (FTE) positions. Poisson regression, with Generalised Estimating Equations, was used to determine injury risks associated with direct care occupations (registered nurses [RNs], licensed practical nurses [LPNs) and care aides [CAs]) by healthcare setting (acute care, nursing homes and community care).

Results

CAs had higher injury rates in every setting, with the highest rate in nursing homes (37.0 injuries per 100 FTE). LPNs had higher injury rates (30.0) within acute care than within nursing homes. Few LPNs worked in community care. For RNs, the highest injury rates (21.9) occurred in acute care, but their highest (13.0) musculoskeletal injury (MSI) rate occurred in nursing homes. MSIs comprised the largest proportion of total injuries in all occupations. In both acute care and nursing homes, CAs had twice the MSI risk of RNs. Across all settings, puncture injuries were more predominant for RNs (21.3% of their total injuries) compared with LPNs (14.4%) and CAs (3.7%). Skin, eye and respiratory irritation injuries comprised a larger proportion of total injuries for RNs (11.1%) than for LPNs (7.2%) and CAs (5.1%).

Conclusions

Direct care occupations have different risks of occupational injuries based on the particular tasks and roles they fulfil within each healthcare setting. CAs are the most vulnerable for sustaining MSIs since their job mostly entails transferring and repositioning tasks during patient/resident/client care. Strategies should focus on prevention of MSIs for all occupations as well as target puncture and irritation injuries for RNs and LPNs.Direct care occupations comprise the largest proportion (58%) of healthcare employees in Canada and consist of registered nurses (RNs), licensed practical nurses (LPNs) and care aides (CAs).^1,2,3 Engkvist et al. (1998) describe a similar grouping of nursing occupations in Sweden with general RNs, state registered nurses (LPNs) and auxiliary nurses (CAs).⁴ Such employees work in various settings (acute care, nursing homes and community care) across the healthcare system. These settings, providing care specific to the needs of patients/residents/clients, have very differing task requirements. Due to shortages in the direct care occupations, workers have more opportunities to choose where they prefer to work. While wage differentials may influence recruitment and retention, as Spetz (2003) has noted, wage increases are not viable solutions for resolving the workforce shortages; work conditions were more important for recruiting and retaining personnel.⁵ Thus a study of differential risk of injuries for the various direct care occupations in different health settings is warranted.RNs can work as independent practitioners in all settings or as team members that assign clients and/or client care functions appropriately. LPNs do not work in isolation but as team members and must exercise clinical judgment in accepting assigned client care functions within their own level of competence.⁶ In many nursing homes, LPNs have been used interchangeably with CAs. CAs must work with the support of RNs and LPNs in providing help to patients/residents/clients with their activities of daily living (such as assistance with personal hygiene, dressing, eating and mobility). This often involves lifting, transferring and repositioning of patients/residents/clients.In the health sector across Canada in 2004, 62.5% of RNs were working in acute care, whereas 13.4% were working in community health and 10.5% in nursing homes.⁷ Jansen et al. (2000) reports that LPNs were predominantly (57%) in acute care, 33% in nursing homes and 10% in community care.⁸ CAs were predominantly working in nursing homes with some in community care and a smaller proportion in acute care.⁹ In the future, it is likely that more nurses will be required to work in nursing homes or community care because of policy changes that focus on reducing the number of chronic care residents in acute care settings, and an ageing population who will need ongoing care whether in their home, assisted living or nursing homes. RNs and LPNs may choose not to work in these settings if they perceive these work environments have higher injury risks than acute care.Changes in the nature of care provided to patients/residents/clients and shifts in work patterns have a great impact on the nursing profession.¹⁰ Because of the different tasks and roles for the three nursing occupations within different care settings, each nursing occupation may have different injury experiences.^8,11,12 Identifying these different patterns of injury through subgroup analysis by care types may allow for more effective targeting of prevention efforts, as well as help nursing staff make informed decisions. The aim of the present study was to examine how injury characteristics and incidence among the three nursing occupations differ in relation to acute care, nursing homes and community care settings in British Columbia (BC), Canada. Time‐at‐risk data can provide more accurate injury rates than general rates published by Workers'' Compensation Boards in Canada and the USA.     

Effect of a general fitness program on musculoskeletal symptoms,clinical status,physiological capacity,and perceived work environment among home care service personnel

The aim of the present controlled study was to evaluate the effect of a general fitness program, performed by an occupational health service, using pre-post assessment for a number of different outcome measures. A total of 160 employees working in the central home care service district of Umeå, Sweden were asked to participate in a program of a 1-year long exercise program. Of the 160 selected, 54 subjects declined to participate and nine subjects were rejected after a medical check up. The remaining 97 subjects participated in a schedule consisting of pre-post medical and physiotherapy examinations, questionnaires concerning sociodemography, musculoskeletal and general health complaints and work environment, physiological tests of cardiovascular fitness, and of strength and endurance of shoulder flexors and knee extensors, and registration of sick leave. The subjects were randomly assigned to an exercise (treatment) or control group. The exercise group trained twice a week for 1 year using a mixed program including exercises for coordination, strength/endurance, and fitness. The test schedule was repeated for both groups after 1 year. The exercise intervention was associated with positive changes in prevalence and intensity of musculoskeletal and psychosomatic complaints, better physiotherapy status (less muscle tightness, better neck mobility, and less tender points), increased shoulder strength and increased coordination in thigh muscles. However, the exercise group reported worse situations post-exercise concerning aspects of their physical and psychosocial work-environment (i.e., concerning ergonomy, influence, appreciation and communication with work manager), which might have been due to stress associated with the exercise situation.     

Reports of work related musculoskeletal injury among home care service workers compared with nursery school workers and the general population of employed women in Sweden.

OBJECTIVES--To describe the nationwide occurrence of work related musculoskeletal injuries among all home care service workers in Sweden, and to identify relative risks and risk factors of the injuries. METHODS--The study was based on work related injuries reported to the Swedish occupational injury information system in 1990-1. The work related musculoskeletal injuries were divided into overexertion accidents and musculoskeletal diseases. The incidence of the injuries in female home care service workers was compared with those in nursery school workers and all other employed women in Sweden. RESULTS--In home care service workers, the annual incidence of injury from overexertion accidents and musculoskeletal diseases were 19.2 and 15.1 per 1000 workers, respectively, which was higher than those in nursery school workers and all employed women in Sweden. For five injury locations including the back, all the age standardised relative risks (SRR) of overexertion accidents exceeded 4.0, and most of those for musculoskeletal diseases were 1.5 or more in home care service workers compared with all other employed women in Sweden. Total duration of sick leave due to overexertion accidents was 7.7 times, and musculoskeletal diseases 3.5 times, longer than in nursery school workers. National loss due to sick leave resulting from only musculoskeletal injuries in home care service workers was about 8.2% of the total work related sick leave in all employed women in Sweden, although the number of home care service workers represented only some 5% of this population. Lifting other people was most frequently reported as the main risk cause of overexertion accidents in both kinds of workers. CONCLUSIONS--The results support the hypothesis that home care service workers have higher annual injury incidence of musculoskeletal injuries than nursery school workers due to physically stressful tasks that are far less common in nursery school workers.     

医护人员医院感染防控知识、态度、行为调查

目的了解重点部门医护人员医院感染防控知识、态度、行为现状,并采取干预措施,为医疗机构医院感染防控工作提供科学依据。方法选择儿科、呼吸科、急诊科3个医院感染防控重点部门所有医护人员进行调查,比较干预前后不同职称医护人员医院感染防控知识、态度、行为变化。结果参与调查人员317名,干预前调查有效问卷275份,问卷有效率86.75%;干预后调查有效问卷311份,问卷有效率98.11%。采取干预措施后,高级、中级、初级及以下职称医护人员知识得分分别为(9.15±2.36)、(7.69±2.05)、(7.73±2.32)分,均高于干预前,分别为(6.46±2.12)、(5.30±1.55)、(6.16±1.80)分,差异均有统计学意义(均P0.05)。干预后初级及以下职称医护人员态度、行为得分分别为(91.50±9.26)、(86.40±14.52)分,均高于干预前,分别为(85.95±13.36)、(76.01±15.25)分,差异均有统计学意义(P0.05);而高级、中级职称医护人员态度、行为得分,差异均无统计学意义(均P0.05)。结论与医院感染防控知识相比,医护人员医院感染防控态度、行为的改变,需投入更多的精力才能取得成效;职称级别相对低的医护人员医院感染防控态度、行为的改变更易于实现。     

对医务人员实施员工帮助计划干预效果评价

目的 评估医务人员的心理现状,并通过员工帮助计划(EAP)服务及其效果评价,探索出一套适合于医疗卫生领域的EAP服务方案.方法 为北京市某综合医院提供为期1年的EAP服务,采用SF-36健康调查量表和JSS量表,对医务人员的生命质量和工作满意度进行调查.结果 工作压力是医务人员最主要的压力源,占63.7%.接受EAP服务组的SF-36量表及JSS量表中各维度(工作性质和上司维度除外)的得分显著高于对照组,差异有统计学意义(P<0.01).结论 医务人员的工作压力较大,对EAP的需求意愿强烈.EAP服务是维护医务人员心理健康、提高生命质量和工作绩效的有效手段,可以推广使用.     

医务人员预防SARS感染的措施探讨

医护人员在诊治、护理严重急性呼吸综合征(Severe Acute Respiratory Syndrome，SARS)患者过程中，通常与患者近距离密切接触，缺乏有效的防护措施，使其成为此病的高危人群。曾经对确诊SARS病例的职业分布进行分析，发现医务人员在各职业人群中的比例最高。     

制造业工人肌肉骨骼疾患和劳动负荷及工作姿势分析

目的 分析制造业工人肌肉骨骼疾患和劳动负荷及工作姿势在不同企业、性别、文化程度、年龄和工龄组间的分布.方法 采用横断面研究设计和问卷调查方法对12家制造业企业5134名工人进行近1年内肌肉骨骼疾患发生情况调查.结果 调查对象在近12个月内身体腰、颈、肩、腕、踝足、膝、髋臀、肘部肌肉骨骼疾患发生率分别为59.7%、47.9%、38.1%、33.7%、26.9%、25.4%、15.2%、14.9%.不同企业工人身体各部位肌肉骨骼疾患发生率的差异有统计学意义(P＜0.05或P＜0.01).耐火材料厂和化纤厂工人肘、腰、腕、足(踝)等部位肌肉骨骼疾患发生率高于其他企业,而服装厂和金刚石厂工人肌肉骨骼疾患发生率低于其他企业.女性工人颈、肩、腕部肌肉骨骼疾患发生率高于男性,差异有统计学意义(P＜0.01).不同文化程度工人身体各部位肌肉骨骼疾患发生率差异有统计学意义(P＜0.05或P＜0.01).颈、肩、肘、腰、髋臀和膝部肌肉骨骼疾患发生率的年龄和工龄组间差异有统计学意义(P＜0.01),肌肉骨骼疾患发生率随年龄和工龄增长而增加.耐火材料厂和化纤厂工人劳动负荷大者和不良姿势者比例较高,金刚石和服装厂工人较低.结论 制造业工人腰、颈、肩、腕部肌肉骨骼疾患发生率较高,性别、文化程度、年龄和工龄对肌肉骨骼疾患的发生存在影响.

Abstract：

Objective To analyze the distribution of the musculoskeletal disorders, work load and working postures in different factories, gender, education levels, age and working years among manufacturing workers. Methods In a cross-sectional study of 5134 manufacturing workers in 12 factories, the morbidities for musculoskeletal disorders in one year period were measured with questionnaires. Results The morbidities for musculoskeletal disorders in body sites: waist, neck, shoulder, wrist, ankle/feet, knee, hip/buttocks and elbows were 59.7%, 47.9%, 38.1%, 33.7%, 26.9%, 25.4%, 15.2%, and 14.9%, respectively in one year period.There were significant differences of morbidities for musculoskeletal symptoms in body sites of workers among different factories (P＜0.05 or P＜0.01 ). The morbidities of musculoskeletal symptoms in elbows, waist, wrists and ankle/feet of the workers in refractory material and chemical fiber factories were higher than those in other factories, the morbidities for musculoskeletal symptoms of workers in garments and diamond factories were lower than those in other factories. The morbidities for musculoskeletal symptoms in neck, shoulders and wrists of female workers were significantly higher than those of male workers (P＜0.01). There were significant differences of the morbidities for musculoskeletal symptoms in body sites among workers with different educational levels(P＜0.05 or P＜0.01 ). There were significant differences of the morbidities for musculoskeletal symptoms in neck, shoulders, wrists, hip/buttocks and knee among groups with different age or different working years (P＜0.01), and the morbidities for musculoskeletal symptoms increased with age and working years. The proportions of unhealthy working postures and high working load among workers in refractory material and chemical fiber factories were higher;, but those in garments and diamond factories were lower.Conclusion The morbidities for musculoskeletal symptoms in waist, neck, shoulder and wrists of workers in manufacturing workers were higher; the gender, education level, age and working years could influenced the morbidities for musculoskeletal disorders.     

广州市外来务工人员艾滋病干预效果评价

目的探索在外来务工人员中有效开展艾滋病健康教育的方法并评价其效果。方法在基线调查基础上，对干预对象采取多种形式的健康教育，1个月后通过问卷调查，对预防艾滋病的知识、态度、行为干预效果进行评价。结果干预后在艾滋病传播途径方面的知晓率有所提高，其中对蚊虫叮咬不会传染艾滋病（干预前为32．9％，干预后为53．3％）、安全套能降低感染性病艾滋病的危险（干预前为45．0％，干预后为60．1％）的知晓率明显提高；在态度方面干预后有显著改变（P〈0．05）。结论掌握安全性行为的观念和技能是外来务工人员艾滋病健康教育干预的重点。     

中老年职工肌肉骨骼功能与工作能力的关系

为了探索肌肉骨骼功能测定在评价工作能力方面的作用，在成都地区对８８名不同职业的中老年职工（４０～６０岁）进行肌肉骨骼功能测定和工作能力指数（ＷＡＩ）测量。结果显示，肌肉骨骼功能指标中，力量指标的平均水平男性显著高于女性，而柔韧性指标女性高于男性。从劳动类型来看，肌肉骨骼功能男性以体力劳动者平均水平最低，女性则以体脑混合型最低。肌肉骨骼功能与工作能力之间存在着密切的相关关系。提示肌肉骨骼功能的测定对评价职工工作能力可能是一组有价值的指标。     

某电解铝厂作业工人慢性肌肉骨骼损伤调查分析

目的 探讨慢性肌肉骨骼损伤与电解铝厂工人职业病的相关性。 方法 选取某电解铝厂100名电解铝工人和100名行政管理工作人员分别设为观察组和对照组,分析比较两组人员慢性肌肉骨骼损伤的检出率。 结果 观察组肌肉骨骼损伤检出率(54.00%)高于对照组(14.00%),差异有统计学意义(P<0.01)。腰背部疼痛检出率最高,观察组肩部、腕部和腰背部肌肉骨骼损伤检出率均高于对照组,差异有统计学意义(P<0.05)。检出率随着工龄的增加而增加(P<0.01),采用固定站立操作姿势工作的人员肌肉骨骼损伤检出率高于采用自由站立和坐姿操作姿势工作的人员(P<0.008)。 结论 保持同一姿势进行长时间作业是导致电解铝厂工人肌肉骨骼损伤的首要原因,应采取相应的措施对病情的发生和发展进行控制。     

Relationship between musculoskeletal disorders and work-related awkward postures among a group of health care workers in a hospital

BACKGROUND: There are few studies in the Italian literature on musculoskeletal disorders (MSD) among health care workers (HCW) keeping and holding awkward postures during their job. OBJECTIVES: The aims of this study were to determine the prevalence of low-back, neck and upper limb complaints and the association between risk factors and MSD in HCW working in 15 wards of the Hospital of Cuneo. METHODS: A questionnaire was submitted to 113 HCW. Information about demographic and occupational factors, and MSD characteristics were collected to be statistically elaborated. RESULTS: The prevalence of complaints regarding at least one of the 3 body regions was 71% in the whole sample (80 subjects). Low back, neck and upper limb were interested, respectively, in 58.4%, 50.4% and 25.7% of the cases. Logistic regression showed a significant association of MSD with score > 7 on the Borg scale (OR = 9.70; CI: 2.01-46.9; p < 0.01), positive musculoskeletal clinical history (OR = 3.67; CI: 1.24-10.88; p < 0.05), and visual defects (OR = 2.88; CI: 1.07-7.81; p < 0.05). Based on the answers from the questionnaire, the onset of MSD was attributed in 41 cases to organizational problems, and in 14 cases to the ergonomic characteristics of the job. CONCLUSIONS: The index of prevalence of MSD associated to work-related awkward postures (71%) is very high, greater than that observed among HCW exposed to manual lifting of weights (21%) in the hospital. Thereafter, assessment of exposure and containment of such occupational risk must be considered useful.