Striving for balance: a grounded theory study of health experiences of nurses with musculoskeletal problems

BACKGROUND: Musculoskeletal disorders (MSD) are one of the major causes of the high levels of long-term sickleave and early retirement, and healthcare personnel are among the occupational groups most affected. Only limited research in the area has focused on the experiences of those affected, and to increase the understanding of MSD, all dimensions of the health experiences need to be taken into consideration. OBJECTIVES: The aim of this paper was to explore the experiences of illness and wellness among female healthcare personnel with musculoskeletal symptoms. DESIGN: A qualitative grounded theory approach guided the study in data collection and analysis. SETTINGS: Medical and surgical ward units at three hospitals; one university hospital and two minor hospitals. PARTICIPANTS: Eight women, registered nurses and nursing aides, with neck, shoulder and/or back problems in early stages. METHODS: A grounded theory approach was used with narrative thematic interviews and parallel data analysis with constant comparisons. RESULTS: The analysis revealed a process of striving to reach a balance between illness and wellness, through accepting and handling illness. Illness appeared as a threat and an experience, while experiences of wellness were simultaneously nurtured. The informants were striving for balance through an inner reasoning leading to acceptance and by handling illness in various ways depending on the character of the illness. CONCLUSION: This paper indicates the diversity of the illness experience, the parallel importance of wellness, and the process of balancing these two in order to feel well enough. As previous research has shown that MSD has a multifactorial cause, a holistic view of health promotion, prevention and rehabilitation may provide a more effective tool than the bodily physical focus most frequently used today.     

Psychosocial work environment of hospital workers: validation of a comprehensive assessment scale

BACKGROUND: Studies have shown that adverse workplace factors can increase the risk of ill-health in hospital workers, but more comprehensive measures of the psychosocial work environment are needed. OBJECTIVES: To test a comprehensive and theory-based psychosocial work environment questionnaire and analyze associations with mental health in a sample of Danish hospital workers. DESIGN AND PARTICIPANTS: Questionnaire-based cross-sectional study with 343 female employees from a large Danish hospital, including patient care workers (nurses, nurse assistants, midwives) and laboratory technicians. METHODS: The psychosocial work environment was measured with 14 scales from the Copenhagen psychosocial questionnaire, version I, covering three main areas: demands at work, work organization and interpersonal relations at work. We further measured self-rated mental health and sociodemographic and employment characteristics of the participants. Cronbach's alphas, analyses of covariance, one-sample t-tests, partial correlations and linear regression models were used to analyze data. RESULTS: Of the 14 work psychosocial workplace scales 12 showed a satisfactory internal consistency (alpha>0.70). Patient care workers had more quantitative, emotional and cognitive demands (all p-values <0.001), higher work pace (p<0.001) and more role conflicts (p=0.01) than laboratory technicians, but also better work organization, including more influence at work, better possibilities for development and a higher meaning of work (all p-values <0.001). Both patient care workers and laboratory technicians had substantially higher scores on the demand scales and lower scores on the influence at work scale than the general Danish working population. Further analyses showed that high levels of demands at work and low levels of work organization and problematic interpersonal relations at work were associated with lower self-rated mental health. CONCLUSION: The Copenhagen psychosocial questionnaire is a suitable instrument to measure the psychosocial work environment of hospital workers. The comprehensive assessment of the psychosocial work environment helps tailoring interventions to the specific needs of different occupational groups.     

列线图可预测首发缺血性脑卒中患者的复发

目的 探索影响首发缺血性脑卒中幸存者复发的危险因素,建立复发预测模型并使用列线图将预测结果可视化。方法 收 集2010年1月~2018年12月入住四川大学华西医院神经内科且符合纳入标准的首发缺血性脑卒中幸存者,共821例幸存者纳入研究,利用R软件对初始人群进行随机抽样,70%纳入训练集建立模型,30%纳入验证集。应用Cox比例风险回归模型对影响首发缺血性脑卒中幸存者复发的因素进行多因素分析,并使用R软件的rms包构造列线图,建立可视化的预测模型。利用C-index和校准曲线来评价模型的预测效果。结果 821例幸存者中,患者3年复发率为16.81%,5年复发率为19.98%;训练集经Cox回归模型多因素分析,年龄>65岁（HR=2.596,P=0.024）、年龄45~64岁（HR=2.510,P=0.006）、mRS评分≥3分（HR=2.284,P=0.004）、冠心病史（HR=1.353,P=0.034）是影响复发的危险因素;并由此建立列线图,3年（5年）复发预测模型的C-index为 0.640（0.671）。结论 首发缺血性脑卒中幸存者复发的影响因素是年龄、mRS评分和周围血管病史,列线图在首发缺血性脑卒中复发预测中有较高的区分度和预测力。     

On a happier note: validation of musical exercise for older persons in long-term care settings

This paper describes a quasi-experimental study of a musical exercise intervention to improve the physical, cognitive, behavioral status and life satisfaction of older residents in a long-term care facility in the United Kingdom. Twenty long-term care residents from three different units (n=60) were recruited and assigned to one of three groups: a control (C) group (no intervention), an occupational therapy (OT) group (comparison group) and a music exercise group (intervention group). Assessments of physical and cognitive status were made pre-intervention and repeated at the end of the 10-week exercise program and again 10 weeks after the completion of the program. The results show that both OT and exercise participation is associated with improvement in physical and cognitive function. However, the exercise group showed significant improvement in more areas than the OT group. The functional benefits from OT and exercise were not sustainable after these activities ceased and showed significant decline 10 weeks after the end of the programs.     

静脉药物配制中心药剂人员的职业防护分析

目的探讨医院静脉药物配制中心（PIVAS）药剂人员职业防护的必要性和意义。方法统计PIVAS工作中危险事件发生的次数。结果2011年出现危险事件一共145次,2012年出现危险事件一共26次,对比2年出现危险事件的概率,差异有统计学意义。结论为了有效规避医院的职业暴露风险,需要对工作人员进行全面的职业安全教育,使其在工作过程中按照具体的操作规程进行相关工作,有效降低出现职业危害的概率。     

2009-2011年宁夏部分企业有毒有害作业工人职业健康监护分析

目的分析宁夏部分有毒有害作业工人职业健康监护现状,为宁夏回族自治区职业病防治决策提供依据。方法对宁夏部分企业有毒有害作业工人职业健康监护情况进行描述性研究,分析不同企业规模、经济类型、行业性质及接触不同有害因素作业工人的健康监护情况,并分析2009～2011年职业健康监护变化趋势。结果2009～2011年宁夏各种有毒有害作业工人职业健康体检受检率呈总体上升趋势。疑似职业病栓出率大型企业最高,小型企业最低;国有企业最高,集体和外资企业最低。煤炭行业、粉尘作业工人疑似职业病检出率最高,粉尘是主要危害因素。结论应进一步加强职业病宣传、监督及人才队伍建设,提高健康监护工作水平。     

不同方法治疗急性小脑梗塞后小脑共济失调的疗效分析

目的：比较不同方法治疗急性小脑梗塞后小脑共济失调的疗效。方法：将我院确诊的急性小脑梗塞后小脑共济失调患者80例随机分为以下四组,每组20例。 A组：常规药物治疗组（补充B族维生素、胞二磷胆碱、抗血小板药物和对症支持治疗）;B组：常规药物治疗组＋功能性电刺激;C组：常规药物治疗组＋作业疗法;D组：常规药物治疗组＋功能性电刺激＋作业疗法。结果：B组、C组和D组的疗效明显高于A组（P〈0.05）;D组的疗效最为明显,高于其他三组（P〈0.05）。结论：单独或联合使用功能性电刺激和/或作业疗法治疗急性小脑梗塞后小脑共济失调的疗效明显高于常规药物组,而联合使用功能性电刺激和作业疗法的治疗效果最为明显。     

加拿大作业表现量表结合作业活动分析在手部损伤患者中的应用

目的 探讨手部损伤患者的作业需求以及基于活动分析的作业干预的效果。方法 选取2021年1月至2022年6月期间因腕手部损伤于南京医科大学第一附属医院康复医学中心进行作业治疗的患者212例,使用加拿大作业表现量表(COPM)进行面谈,收集患者“想做”“需要做”“被期望去做”但目前因损伤无法完成的作业需求,由2名高年资作业治疗师对作业需求进行活动分析,找出影响作业需求的作业成分,设计针对性的干预方案。干预前后采用COPM对表现和满意度进行评价。结果 累计收集到84项作业需求,涉及工作、基本日常生活活动、工具性日常生活活动、休闲娱乐和睡眠5大领域,累及率较高的作业活动是使用电脑(8.28%)、用筷子吃饭(6.42%)、拧毛巾(6.25%)、骑行交通工具出行(4.90%)和提重物(4.73%)等。治疗后,COPM表现分和满意度显著提高(t> 16.572, P <0.001)。结论 手部损伤患者作业需求具有当地文化特点;采用基于活动分析的作业干预能有效满足患者的作业需求。