Influence of extended working hours and physical recovery on absenteeism in the footwear industry from a system dynamics model

Objectives. Work-related musculoskeletal disorders (WMSDs) are recurrent in the footwear industry, resulting in absenteeism. This study aimed to quantitatively analyze the influence of overtime work and physical recovery time on the occurrence of WMSD-related absenteeism using a system dynamics model. As ergonomic methods have limitations in quantitatively simulating the behavior of these relationships, the integration of computational modeling techniques has emerged as a methodological alternative to bridge this gap. Methods. An ergonomic work analysis (EWA) was developed in a production cell of a large company. A model of causal relationships (causal loop diagram) and a simulation model (flow and stock diagram) were then developed, where three scenarios for overtime and physical recovery time were analyzed. Results. Working an additional hour resulted in a 42% increase in physical overload, leading to 7.62 leave requests per year and 78.7 days of employee absenteeism. Increasing the physical recovery time by 15 min reduced the overload to 36.5%, resulting in 6.8 leave requests per year and 71.1 days of employee absenteeism. Conclusions. Properly managing excess workload and providing adequate physical recovery for professionals is necessary to mitigate the productivity impacts of absenteeism in the footwear industry.

Educational and occupational aspirations of adolescent and young adult cancer survivors: a qualitative analysis

PURPOSE

Adolescent and young adult cancer survivors (AYACS) are patients diagnosed with cancer between 15 and 39 years of age. AYACS are often derailed from planned educational and occupational endeavors due to disruption from cancer treatment and its consequences. The study objective was to examine how a personal cancer diagnosis impacted AYACS' experiences related to these endeavors.

METHODS

Semi-structured interviews were conducted as part of a larger study assessing psychosocial challenges among a younger AYACS subset aged 15-25 years old at the time of cancer diagnosis. Interviews were coded based on responses and were used to develop themes related to educational and occupational endeavors.

RESULTS

Data were collected from 35 participants. Five themes emerged: (1) Pauses in educational attainment had a detrimental effect on educational goals for some participants, but further solidified and sculpted educational plans for others; (2) Although participants experienced challenges accomplishing educational goals, supportive school environments helped surmount these challenges; (3) Participants reflected on rethinking career aspirations, though some desired to pursue the same occupation planned before cancer diagnosis; (4) Participants experienced challenges, including physical and cognitive limitations, upon returning to work; and (5) Participants valued autonomy and normalcy through work and appreciated supportive and flexible work environments.

CONCLUSIONS

AYACS prioritize professional achievement, yet encounter challenges in achieving professional goals. Our findings create a foundation for developing and testing prospective interventions to promote continuance of school and work during cancer treatment when feasible, and proactive reintegration strategies for those who paused professional goals due to cancer treatment.

From home to health: Telerehabilitation's contribution to physical activity and quality of life in young adult teleworkers

BACKGROUND

The global implementation of full-time telework became widespread during the new normal conditions following the pandemic, resulting in reduced physical activity (PA) among teleworkers and young adults. It is vital to comprehend how telehealth interventions favorably impact PA levels and overall well-being of young adults who face increasingly blurred boundaries between work and home life.

OBJECTIVES

The aim of this study is to examine the effect of telerehabilitation (TR) on PA levels and quality of life (QoL) in young adult teleworkers.

METHODS

A quasi-experimental study was conducted on 82 teleworkers (54 females and 28 males). Levels of PA and QoL were assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and the Health-Related Quality of Life (HRQOL-14) questionnaire. TR was provided to all participants for four weeks, three times a week, for 40 minutes per session. Levels of PA and QoL were evaluated at baseline and after four weeks of the intervention. Data were analyzed using descriptive and inferential statistics.

RESULTS

After four weeks of TR, there has been a significant improvement in the scores of IPAQ and HRQOL-14 (p < 0.05). In regards to IPAQ-SF results, TR had a significant effect on the sitting or sedentary behavior of the teleworkers.

CONCLUSION

The results showed that a short-term TR intervention improved both the level of PA and QoL in young adult teleworkers. Therefore, TR may be an effective treatment approach to improve PA and QoL and promote a healthy lifestyle in teleworkers.

Influence of Visual Stimulus Changes in a Virtual Environment on Postural Control: Focusing on a Hallway Walking Simulation

The purpose of this study was to clarify the effects of the standing center of gravity sway by providing visual stimulus information as if the subjects were walking in virtual reality (VR) and by monitoring conditions with different corridor widths. We included 25 healthy young individuals in our study. The center of gravity sway was measured during open- and closed-eye static standing using images of walking in corridors of different widths (780 and 1600 mm) presented on a VR and personal computer monitor (Monitor). The parameters measured for the center of gravity sway were swing path length (SPL), height of excursion (HoE), and width of excursion (WoE). The results showed that the SPL and HoE values were significantly greater in the VR group than those in the Monitor group. The greater center of gravity sway in the VR compared with the Monitor group can be attributed to the ability of the head-mounted VR display to cover the entire field of vision and its head-tracking function. There was no change in the center of gravity sway with respect to the corridor width, which may be because the width of the corridor alone did not provide sufficient visual stimulation to affect physical function. This research could lead to further studies which could impact the motivation of patients for rehabilitation therapies.

Caring for those who care: key challenges and improvement opportunities for health professionals working with children with disabilities

This paper investigates the challenges faced by health professionals working with children with disabilities, with the aim of identifying areas for improvement. Employing a focus group method, the study involved knowledge levelling, discussions, problematization, cause formulation, and validation. A diverse team of ten professionals participated, including physiotherapists, speech therapists, occupational therapists, psychologists, nursing technicians, and social workers. Findings reveal organisational inflexibility in appointment scheduling, lack of deadlines affecting case monitoring, and the mental strain of immediate clinical responses. Effective communication and multidisciplinary care emerge as beneficial. Proposed improvements include flexible space utilisation, enhanced room design, structured collaboration training, role clarification, parent partnerships, flexible scheduling, and continuous professional development. This study unveils unique challenges and rewards in the healthcare environment, offering insights into causative factors and practical strategies for enhancing the work of health professionals working with children with disabilities.

Self-rated health and its bidirectional relationship with burnout, sleep quality and somatic symptoms in a general adult population

The aim of this study was to investigate how self-rated health (SRH) reflects ongoing ill-health and how SRH is associated with previous ill-health and/or predicts future ill-health such as burnout, disturbed sleep, and somatic symptoms. The study used two waves from the population-based Västerbotten Environmental and Health Study in which 2 336 adult persons participated by answering a questionnaire at two time points three years apart. Hierarchical and logistic regression analyses were conducted, thus treating all variables both continuously (degree) and categorically (case). The analyses were performed both cross-sectionally and longitudinally. The results showed bidirectionality between suboptimal SRH and burnout, disturbed sleep and somatic severity caseness. Moreover, degree of poor SRH was more likely to occur simultaneously to high degrees of burnout and somatic severity than to degree of poor sleep quality. Also, caseness of burnout, disturbed sleep and somatic severity increased the risk of simultaneous suboptimal SRH. Finally, the results showed that degree of burnout three years earlier, predicted degree of poor SRH, and that degree of poor SRH predicted degree of sleep three years later. In conclusion, in a population-based, normal adult sample there is a bidirectional relationship between suboptimal SRH and caseness of burnout, disturbed sleep quality and somatic symptoms, but not between degree of these symptoms. The results can have implications for health care meeting patients complaining about poor general health.

A Clustering Study of Sociodemographic Data, Dietary Patterns, and Gut Microbiota in Healthy and Breast Cancer Women Participating in the MICROMA Study

SCOPE

This work is part of the clinical study NCT03885648 registered in ClinicalTrials.gov, aimed at studying the relationship among breast cancer, microbiota, and exposure to environmental pollutants. As a first step, we characterized and evaluated risk factors of the participants.

METHODS AND RESULTS

A case-control study was designed with breast cancer (cases, n = 122) and healthy women (controls, n = 56) recruited in two hospitals of Andalusia (Southern Spain). Participants answered questionnaires of Mediterranean diet adherence and food frequency. Data were collected from medical histories and microbiota was analyzed on stool samples. Most cases (78.2%) were diagnosed as stages I and II. Cases had higher age, body mass index (BMI), glucose, cholesterol, and potassium values than controls. Cases exhibited higher adherence to the Mediterranean diet and their food consumption was closer to that dietary pattern. A hierarchical cluster analysis revealed that the Bacillota/Bacteroidota ratio was the most relevant variable in women with breast cancer, which was higher in this group compared with controls.

CONCLUSION

Although cases exhibited higher adherence to the Mediterranean diet compared with controls, they presented features and microbiota alterations typical of the metabolic syndrome, probably due to their higher BMI and reflecting changes in their lifestyle around the time of diagnosis.

ISCCM Position Statement on the Approach to and Management of Critically Ill Patients with Tuberculosis

Tuberculosis (TB) is an important cause of morbidity and mortality globally. About 3-4% of hospitalized TB patients require admission to the intensive care unit (ICU); the mortality in these patients is around 50-60%. There is limited literature on the evaluation and management of patients with TB who required ICU admission. The Indian Society of Critical Care Medicine (ISCCM) constituted a working group to develop a position paper that provides recommendations on the various aspects of TB in the ICU setting based on available evidence. Seven domains were identified including the categorization of TB in the critically ill, diagnostic workup, drug therapy, TB in the immunocompromised host, organ support, infection control, and post-TB sequelae. Forty-one questions pertaining to these domains were identified and evidence-based position statements were generated, where available, keeping in focus the critical care aspects. Where evidence was not available, the recommendations were based on consensus. This position paper guides the approach to and management of critically ill patients with TB.

How to cite this article

Chacko B, Chaudhry D, Peter JV, Khilnani G, Saxena P, Sehgal IS, et al. isccm Position Statement on the Approach to and Management of Critically Ill Patients with Tuberculosis. Indian J Crit Care Med 2024;28(S2):S67-S91.

Return to work for stroke survivors with aphasia: A quantitative scoping review

The international incidence of stroke in people of working age is rising. As such, meaningful work return is a major rehabilitation goal for many individuals, including those with aphasia. This scoping review aimed to outline the post-stroke aphasia evidence related to work outcomes, factors influencing employment along with contemporary vocational-language and communication rehabilitation practice. The review employed terms related to aphasia, stroke, rehabilitation, and return to work in publications preceding 25.6.2023. Data were descriptively analysed, and vocational outcomes were summarized at defined timepoints. Of the 908 articles reviewed, 31 papers were included. Individuals with post-stroke aphasia consistently have lower rates of return to work than those post-stroke without aphasia. Employment at one year was 34.29% for those with aphasia compared to 58.46% for people without aphasia. No literature reported vocational-language assessment practices and there were minimal work-focused aphasia interventions identified. There was insufficient evidence to clearly identify person-related, rehabilitation, workplace or other factors influencing work return. This scoping review has identified that there are gaps in knowledge about the factors that influence work return and targeted vocational rehabilitation for this group. Future research to optimize return to work for individuals with aphasia is recommended.

The Impact of Night Work on the Sleep and Health of Medical Staff-A Review of the Latest Scientific Reports

Introduction: Employees working in shifts are exposed to many threats affecting their health, quality of life and safety at work. Those who perform their work only at night are particularly vulnerable. The purpose of the review is to identify risks to the health, quality of life and sleep of shift health workers. Method: A systematic review (SR) was used in the analysis. Electronic databases were searched. The search was limited to the latest studies published in the last five years: 2019-2023. Results: Finally, 36 articles were included in the review. Most authors have shown a link between sleep disturbance or its quality and shift work/night work. Moreover, a three-shift schedule was the most significant factor for poorer subjective sleep quality when compared to other work schedules. Furthermore, many authors have shown a link between shift/night work and health problems, which include cardiometabolic risk, glucose intolerance, breast cancer and immune vulnerability. Conclusions: The research results clearly show a significant impact of night work on the increased risk of sleep disorders and health disturbance. Healthcare workers should be aware of the risks associated with night work in order to take measures preventing sleep/health problems. Shift/night workers should have the opportunity to be screened for disorders linked with their work.

Airway Diseases Related to the Use of Cleaning Agents in Occupational Settings

Exposure to disinfectants and cleaning products (DCPs) is now a well-established risk factor for work-related asthma (WRA). However, questions remain on the specific causal agents and pathophysiological mechanisms. Few studies have also reported an association between DCPs and rhinitis or chronic obstructive pulmonary disease. This review discusses the recent evidence pertaining to airway diseases attributable to occupational exposure to DCPs. In contrast to other agents, the incidence of WRA due to DCPs has increased over time. The use of DCPs in spray form has clearly been identified as an added risk factor. The mechanisms for WRA associated with DCPs remain poorly studied; however, both allergic and nonallergic responses have been described, with irritant mechanisms thought to play a major role. An early diagnostic workup based on clinical assessment accompanied by evaluation of lung function and immunological and airway inflammatory markers is important to guide optimal care and exposure avoidance to the implicated agent. Future research should focus on the effects of "green" products, pathophysiological mechanisms, and quantitative exposure assessment including the use of barcode-based methods to identify specific agents. There is an urgent need to strengthen preventive measures and interventions to reduce the burden of airway diseases associated with DCPs.

A workplace violence prevention program targeting high-risk patients in emergency departments

Objective

Patient violence in emergency departments (EDs) may be prevented with proactive mitigation measures targeting potentially violent patients. We aimed to evaluate the effects of two interventions guided by a validated risk-assessment tool.

Methods

A prospective interventional study was conducted among patients ≥10 years who visited two EDs in Michigan, USA, from October 2022 to August 2023. During triage, the ED nurses completed the Aggressive Behavior Risk Assessment Tool for EDs (ABRAT-ED) to identify high-risk patients. Following the baseline observational period, interventions were implemented stepwise for the high-risk patients: phase 1 period with signage posting and phase 2 period with a proactive Behavioral Emergency Response Team (BERT) huddle added to the signage posting. Before ED disposition, any violent events and their severities were documented. The data were retrieved retrospectively after the study was completed.

Results

Of 77,424 evaluable patients, 546 had ≥1 violent event. The violent event rates were 0.93%, 0.68%, and 0.62% for baseline, phase 1, and phase 2, respectively. The relative risk of violent events for phase 1 compared to the baseline was 0.73 (95% confidence interval [CI]: 0.59‒0.90; p = 0.003). The relative risk for phase 2 compared to phase 1 was 0.92 (95% CI: 0.76‒1.12; p = 0.418).

Conclusion

The use of signage posting as a persistent visual cue for high-risk patients identified by ABRAT-ED appears to be effective in reducing the overall violent event rates. However, adding proactive BERT huddle to signage posting showed no significant reduction in the violent event rates compared to signage posting alone.

The Prevalence and Benefits of Self-Compassion Among Professional Caregivers

OBJECTIVE

Self-compassion is a healthy way of responding to challenges that may help long-term care professional caregivers (ie, nursing assistants and personal care aides) cope with stress, but its use may vary in important ways. This study explored the relationships between self-compassion and caregiver demographic characteristics, anxiety and depressive symptoms, and job satisfaction in a large racially/ethnically diverse sample of professional caregivers.

DESIGN

Cross-sectional self-report questionnaire.

SETTING AND PARTICIPANTS

A total of 391 professional caregivers, including nursing assistants and personal care aides from 10 nursing homes and 3 assisted living communities in New York, California, and North Carolina.

METHODS

Professional caregivers were invited to complete an online questionnaire regarding stress and coping. Self-compassion was measured using the Self-Compassion for Youth Scale; anxiety and depressive symptoms were assessed using standardized screeners; and job satisfaction was assessed via an item used in a national survey. Self-compassion scores were represented by total scores and individual subscale scores. Analysis of variance was used to examine differences in self-compassion scores based on demographic characteristics, and correlation coefficients were used to explore relationships between self-compassion and mental health symptoms and job satisfaction.

RESULTS

Significant differences were found in self-compassion based on age, race/ethnicity, place of birth, and education. In general, older caregivers, caregivers with higher education, and caregivers born outside the United States had the highest self-compassion, whereas White caregivers had the lowest self-compassion. Self-compassion was negatively associated with anxiety and depressive symptoms and positively associated with job satisfaction.

CONCLUSION AND IMPLICATIONS

Professional caregivers' use of self-compassion to cope with challenges may depend on characteristics and life experiences influenced by their sociocultural background. Given the link between self-compassion and lower mental health symptoms and higher job satisfaction, it may be helpful to design and implement interventions with these differences in mind.

"This is it…this is our normal" - the voices of family members and first responders experiencing duty-related trauma in Ireland

BACKGROUND

Compared to other occupational groups, first responders (FR) experience worse mental health outcomes due to duty-related trauma and occupational stressors. Despite their best efforts, they bring this stress home to friends and family. Consequently, FR and their supporters suffer from increased psychosocial difficulties and experience stigma and other barriers to help-seeking. Prior work offers little opportunity for open dialogue and shared understanding of the repercussions of this occupation for all members of the first responder community. In this qualitative study, we aimed to: (i) explore the lived experience of Irish FR and their family members (FM) related to occupational stressors, and (ii) identify opportunities to engage FM with existing organizational supports available for FR.

METHODS

Using a community based participatory research (CBPR) approach, we conducted six focus groups involving a total of fourteen participants comprising FR, organizational representatives, and FM. All focus groups were audio recorded, transcribed, and analyzed using reflexive thematic analysis.

FINDINGS

FR and FM shared their experiences of both joining and learning to live as members of the FR community in Ireland. Through our analysis, we identified a main theme of 'crossing thresholds', characterizing their transformative learning experiences. This learning experience includes recognizing the consequences of this new role for them as individuals and for their relationships. Participants also shared how they have learned to cope with the consequences of their roles and what they need to better support each other.

CONCLUSIONS

FM are often unheard, hidden members of the first responder community in Ireland, highlighting an unmet need for FR organizations to acknowledge FM role in supporting FR and to provide them with the appropriate training and resources required. Training for new recruits needs to move beyond the tokenistic involvement of FM and encourage knowledge sharing among experienced and novice members. Cultural change is required to support help-seeking among FR and foster a sense of peer support and community among families.

Oil and Gas Extraction Industry Workers' Compensation Claims and Proposed Safety Interventions

OBJECTIVE

This study analyzed Ohio workers' compensation data to identify potential prevention strategies for common oil and gas extraction industry claims.

METHODS

Claim rates for 2001-2018 were calculated per full-time equivalent employee. Descriptive analyses on free-text descriptions of lost-time (LT) claims (>7 days away from work) identified common characteristics among claims and injured workers.

RESULTS

Among 3134 claims, 860 (27%) were LT. The industry group, drilling contractors, experienced the highest LT claims rate, whereas the cost from servicing contractors was the highest. Contact with objects and equipment caused the highest LT claims rate. The most frequent LT occupation was roustabout, and the most frequent LT work activity was material handling. Transportation incidents caused most fatalities and hospitalizations. Over half of LT claims were from short-tenured workers.

CONCLUSIONS

Both proven and innovative approaches are needed to reduce severe workers' compensation claims in this industry.

The effect of workplace bullying and self-efficacy on emotional distress among hospital nurses

AIMS

This study intended to explore the workplace bullying, self-efficacy and emotional distress of the nursing staff and determine the predictors of nursing staff's emotional distress.

METHODS

Cross-sectional and correlation designs were used, collecting data including socio-demographic data, workplace bullying, self-efficacy and emotional distress scales.

RESULTS

Results showed that the frequency of poor sleep quality in the recent 2 weeks, working in the intensive care centre or emergency room, high workplace bullying and low self-efficacy were the main predictors of emotional distress in nursing staff.

CONCLUSION

Nursing supervisors are advised to design suitable shift schemes to allow adequate time for nurses to maintain proper rest and develop a safety notification system to give bullied victims the assurance of safety. The design and implementation of the programs are encouraged to improve self-efficacy among nurses by strengthening the training of social skills, improving employees' communication skills and their relationships with other employees.

Assaults and Microaggressions Against Psychiatric Residents: Findings from a US Survey

OBJECTIVES

Psychiatric physicians may experience higher rates of assault than those in other fields. For many reasons, residents may be especially vulnerable. This study updates rates of assaults among US psychiatry residents as well as the reporting rates and emotional effects of these incidents. Little data exists to examine rates of microaggressions against psychiatry residents.

METHODS

A cross-sectional online survey was distributed through a national residency database via a snowball-sampling approach between June and September of 2021. The questionnaire asked about experiences of verbal, physical, and sexual assaults, as well as microaggressions and their impact. Descriptive analyses of the obtained data were conducted.

RESULTS

The survey was completed by 275 psychiatry residents from 29 states (63.6% women). At least one form of assault was experienced by 78.9% of participants with 74.5% experiencing verbal, 22.2% experiencing physical, and 6.2% experiencing sexual assault. At least one type of microaggression was experienced by 86.9% of trainees. Elevations in PTSD scores were seen in residents who identified as women and non-White and those physically injured or sexually assaulted. While 92.7% of residents stated their program provided training about assault, 25% of residents indicated they had no training on recognizing and responding to microaggressions.

CONCLUSIONS

Psychiatric residents experience widespread assault and microaggressions in the clinical setting but often do not report them. Due to the ubiquitous nature of these events, programs should provide training about early recognition and de-escalation techniques for agitation, responding effectively to microaggressions, and the importance of reporting events.

Association between work-related factors and health behaviour clusters among Finnish private-sector service workers

PURPOSE

We examined how work-related factors associate with several health behaviours that appear together among the large, but less-studied, blue- and pink-collar worker group, which is characterized by low education and income levels.

METHODS

In 2019, we conducted a cross-sectional survey among private sector service workers (n = 5256) in Finland. We applied two-step cluster analysis to identify groups on the basis of leisure-time physical activity, sleep adequacy, frequency of heavy drinking, smoking status, and frequency of fruit, vegetable and berry consumption. We examined the associations with work-related factors, using multinomial regression analyses and adjusting for confounding factors.

RESULTS

We identified six clusters labelled as Moderately Healthy (28% of the participants), Healthy - Vigorous Exercise (19%), Sedentary Lifestyle (16%), Inadequate Sleep (15%), Mixed Health Behaviours (15%), and Multiple Risk Behaviours (8%). Those who perceived their work to be mentally or physically strenuous more commonly belonged to the Inadequate Sleep and Multiple Risk Behaviours clusters. Time pressure made belonging to the Inadequate Sleep, Mixed Health Behaviours, and Multiple Risk Behaviours clusters more likely. Those who were dissatisfied with their work more often belonged to the Healthy - Vigorous Exercise, Inadequate Sleep, and Multiple Risk Behaviours clusters.

CONCLUSION

In addition of finding several considerably differing health behaviour clusters, we also found that adverse working conditions were associated with clusters characterized by multiple risk behaviours, especially inadequate sleep. Private-sector service workers' working conditions should be improved so that they support sufficient recovery, and occupational health services should better identify co-occurring multiple risk behaviours.

Exercise Therapy for Treatment of Acute Non-specific Low Back Pain: A Cochrane Systematic Review and Meta-analysis of Randomized Controlled Trials

OBJECTIVE

To assess the effectiveness of exercise for acute non-specific low back pain (LBP) vs our main comparisons: (1) sham treatment and (2) no treatment at short term (main follow-up time).

DATA SOURCES AND STUDY SELECTION

A comprehensive search up till November 2021 was conducted in numerous databases for randomized controlled trials on the effectiveness of exercise in adults with acute LBP (<6 weeks). Studies examining LBP with a specific etiology were excluded. The primary outcomes were back pain, back-specific functional status, and recovery.

DATA EXTRACTION

Two review authors independently conducted the study selection, risk of bias assessment, and data extraction. GRADE was used to assess the certainty of the evidence.

DATA SYNTHESIS

We identified 23 randomized controlled trials (2674 participants). There is very low-certainty evidence that exercise therapy compared with sham/placebo treatment has no clinically relevant effect on pain (mean difference [MD] -0.80, 95% confidence interval [CI] -5.79 to 4.19; 1 study, 299 participants) and on functional status (MD 2.00, 95% CI -2.20 to 6.20; 1 study, 299 participants) in the short term. There is very low-quality evidence which suggests no difference in effect on pain and functional status for exercise vs no treatment (2 studies; n=157, not pooled due to heterogeneity) at short-term follow-up. Similar results were found for the other follow-up moments. The certainty of the evidence was downgraded because many randomized controlled trials had a high risk of bias, were small in size, and/or there was substantial heterogeneity.

CONCLUSION

Exercise therapy compared with sham/placebo and no treatment may have no clinically relevant effect on pain or functional status in the short term in people with acute non-specific LBP, but the evidence is very uncertain. Owing to insufficient reporting of adverse events, we were unable to reach any conclusions on the safety or harms related to exercise therapy.

Alcohol Consumption Patterns and Mortality Among Older Adults With Health-Related or Socioeconomic Risk Factors

Importance

Alcohol consumption is a leading cause of morbidity and mortality that may be more important in older adults with socioeconomic or health-related risk factors.

Objective

To examine the association of alcohol consumption patterns with 12-year mortality and its modification by health-related or socioeconomic risk factors.

Design, Setting, and Participants

This prospective cohort study used data from the UK Biobank, a population-based cohort. Participants were current drinkers aged 60 years or older. Data were analyzed from September 2023 to May 2024.

Exposure

According to their mean alcohol intake in grams per day, participants' drinking patterns were classified as occasional: ≤2.86 g/d), low risk (men: >2.86-20.00 g/d; women: >2.86-10.00 g/d), moderate risk (men: >20.00-40.00 g/d; women: >10.00-20.00 g/d) and high risk (men: >40.00 g/d; women: >20.00 g/d).

Main Outcomes and Measures

Health-related risk factors were assessed with the frailty index, and socioeconomic risk factors were assessed with the Townsend deprivation index. All-cause and cause-specific mortality were obtained from death certificates held by the national registries. Analyses excluded deaths in the first 2 years of follow-up and adjusted for potential confounders, including drinking patterns and preferences.

Results

A total of 135 103 participants (median [IQR] age, 64.0 [62.0-67.0] years; 67 693 [50.1%] women) were included. In the total analytical sample, compared with occasional drinking, high-risk drinking was associated with higher all-cause (hazard ratio [HR], 1.33; 95% CI, 1.24-1.42), cancer (HR, 1.39; 95% CI, 1.26-1.53), and cardiovascular (HR, 1.21; 95% CI, 1.04-1.41) mortality; moderate-risk drinking was associated with higher all-cause (HR, 1.10; 95% CI, 1.03-1.18) and cancer (HR, 1.15; 95% CI, 1.05-1.27) mortality, and low-risk drinking was associated with higher cancer mortality (HR, 1.11; 95% CI, 1.01-1.22). While no associations were found for low- or moderate-risk drinking patterns vs occasional drinking among individuals without socioeconomic or health-related risk factors, low-risk drinking was associated with higher cancer mortality (HR, 1.15; 95% CI, 1.01-1.30) and moderate-risk drinking with higher all-cause (HR, 1.10; 95% CI, 1.01-1.19) and cancer (HR, 1.19; 95% CI, 1.05-1.35) mortality among those with health-related risk factors; low-risk and moderate-risk drinking patterns were associated with higher mortality from all causes (low risk: HR, 1.14; 95% CI, 1.01-1.28; moderate risk: HR, 1.17; 95% CI, 1.03-1.32) and cancer (low risk: HR, 1.25; 95% CI, 1.04-1.50; moderate risk: HR, 1.36; 95% CI, 1.13-1.63) among those with socioeconomic risk factors. Wine preference (>80% of alcohol from wine) and drinking with meals showed small protective associations with mortality, especially from cancer, but only in drinkers with socioeconomic or health-related risk factors and was associated with attenuating the excess mortality associated with high-, moderate- and even low-risk drinking.

Conclusions and Relevance

In this cohort study of older drinkers from the UK, even low-risk drinking was associated with higher mortality among older adults with health-related or socioeconomic risk factors. The attenuation of mortality observed for wine preference and drinking only during meals requires further investigation, as it may mostly reflect the effect of healthier lifestyles, slower alcohol absorption, or nonalcoholic components of beverages.

Nurse and midwife involvement in task-sharing and telehealth service delivery models in primary care: A scoping review

AIM

To synthesise and map current evidence on nurse and midwife involvement in task-sharing service delivery, including both face-to-face and telehealth models, in primary care.

DESIGN

This scoping review was informed by the Joanna Briggs Institute (JBI) Methodology for Scoping Reviews.

DATA SOURCE/REVIEW METHODS

Five databases (Ovid MEDLINE, Embase, PubMed, CINAHL and Cochrane Library) were searched from inception to 16 January 2024, and articles were screened for inclusion in Covidence by three authors. Findings were mapped according to the research questions and review outcomes such as characteristics of models, health and economic outcomes, and the feasibility and acceptability of nurse-led models.

RESULTS

One hundred peer-reviewed articles (as 99 studies) were deemed eligible for inclusion. Task-sharing models existed for a range of conditions, particularly diabetes and hypertension. Nurse-led models allowed nurses to work to the extent of their practice scope, were acceptable to patients and providers, and improved health outcomes. Models can be cost-effective, and increase system efficiencies with supportive training, clinical set-up and regulatory systems. Some limitations to telehealth models are described, including technological issues, time burden and concerns around accessibility for patients with lower technological literacy.

CONCLUSION

Nurse-led models can improve health, economic and service delivery outcomes in primary care and are acceptable to patients and providers. Appropriate training, funding and regulatory systems are essential for task-sharing models with nurses to be feasible and effective.

IMPACT

Nurse-led models are one strategy to improve health equity and access; however, there is a scarcity of literature on what these models look like and how they work in the primary care setting. Evidence suggests these models can also improve health outcomes, are perceived to be feasible and acceptable, and can be cost-effective. Increased utilisation of nurse-led models should be considered to address health system challenges and improve access to essential primary healthcare services globally.

REPORTING METHOD

This review is reported against the PRISMA-ScR criteria.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

PROTOCOL REGISTRATION

The study protocol is published in BJGP Open (Moulton et al., 2022).

A comparative analysis of sleep quality and time management skills between shift and non-shift police officers

PURPOSE

The sleep quality of police officers working in shifts is negatively affected due to long working hours and sleeping less during the day. In our study, we aimed to examine the differences in sleep quality and time management skills in police officers working with shift and non-shift system.

METHODS

106 police officers, 46 of whom worked in the shift system, 60 of whom worked in the non-shift system, and whose mean age was 27.6 ± 0.9 [min 20, max 40] were included in the study. Sleep quality was assessed with the Pittsburgh Sleep Quality Index[PSQI] and time management skills with the Time Management Questionnaire[TMQ].

RESULTS

While the TMQ total score was 80.91 ± 12.61 for police officers working in shifts, it was 72.41 ± 12.62 for police officers working non-shift. The PSQI total score was 5 in both groups. There was a difference between the TMQ time planning, TMQ time attitudes sub-dimensions, and TMQ total scores of police officers working in the shift system and those working in the non-shift system[p < 0.05]. While poor sleep quality was observed between both groups, there was no difference in sleep quality[p > 0.05].

CONCLUSION

There was no difference in sleep quality between police officers working in shifts and non-shifts. However, the time management skills of police officers working in shifts were better than those of police officers working in non-shifts. We believe that training programs to improve sleep health and time management skills in police officers are needed for both the sleep quality and well-being of police officers and public safety.

Why do acute healthcare staff behave unprofessionally towards each other and how can these behaviours be reduced? A realist review

Background

Unprofessional behaviour in healthcare systems can negatively impact staff well-being, patient safety and organisational costs. Unprofessional behaviour encompasses a range of behaviours, including incivility, microaggressions, harassment and bullying. Despite efforts to combat unprofessional behaviour in healthcare settings, it remains prevalent. Interventions to reduce unprofessional behaviour in health care have been conducted - but how and why they may work is unclear. Given the complexity of the issue, a realist review methodology is an ideal approach to examining unprofessional behaviour in healthcare systems.

Aim

To improve context-specific understanding of how, why and in what circumstances unprofessional behaviours between staff in acute healthcare settings occur and evidence of strategies implemented to mitigate, manage and prevent them.

Methods

Realist synthesis methodology consistent with realist and meta-narrative evidence syntheses: evolving standards reporting guidelines.

Data sources

Literature sources for building initial theories were identified from the original proposal and from informal searches of various websites. For theory refinement, we conducted systematic and purposive searches for peer-reviewed literature on databases such as EMBASE, Cumulative Index to Nursing and Allied Health Literature and MEDLINE databases as well as for grey literature. Searches were conducted iteratively from November 2021 to December 2022.

Results

Initial theory-building drew on 38 sources. Searches resulted in 2878 titles and abstracts. In total, 148 sources were included in the review. Terminology and definitions used for unprofessional behaviours were inconsistent. This may present issues for policy and practice when trying to identify and address unprofessional behaviour. Contributors of unprofessional behaviour can be categorised into four areas: (1) workplace disempowerment, (2) organisational uncertainty, confusion and stress, (3) (lack of) social cohesion and (4) enablement of harmful cultures that tolerate unprofessional behaviours. Those at most risk of experiencing unprofessional behaviour are staff from a minoritised background. We identified 42 interventions in the literature to address unprofessional behaviour. These spanned five types: (1) single session (i.e. one-off), (2) multiple sessions, (3) single or multiple sessions combined with other actions (e.g. training session plus a code of conduct), (4) professional accountability and reporting interventions and (5) structured culture-change interventions. We identified 42 reports of interventions, with none conducted in the United Kingdom. Of these, 29 interventions were evaluated, with the majority (n = 23) reporting some measure of effectiveness. Interventions drew on 13 types of behaviour-change strategy designed to, for example: change social norms, improve awareness of unprofessional behaviour, or redesign the workplace. Interventions were impacted by 12 key dynamics, including focusing on individuals, lack of trust in management and non-existent logic models.

Conclusions

Workplace disempowerment and organisational barriers are primary contributors to unprofessional behaviour. However, interventions predominantly focus on individual education or training without addressing systemic, organisational issues. Effectiveness of interventions to improve staff well-being or patient safety is uncertain. We provide 12 key dynamics and 15 implementation principles to guide organisations.

Future work

Interventions need to: (1) be tested in a United Kingdom context, (2) draw on behavioural science principles and (3) target systemic, organisational issues.

Limitations

This review focuses on interpersonal staff-to-staff unprofessional behaviour, in acute healthcare settings only and does not include non-intervention literature outside the United Kingdom or outside of health care.

Study registration

This study was prospectively registered on PROSPERO CRD42021255490. The record is available from: www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021255490.

Funding

This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR131606) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 25. See the NIHR Funding and Awards website for further award information.

Coping with Distress and Building Resilience among Emergency Nurses: A Systematic Review of Mindfulness-based Interventions

Aims and background

Emergency nurses are working in a stress-prone environment. It is critical to ensure adequate psychological aids to cope with the distress at work. The objective of this systematic review was to explore and evaluate the studies that have discussed the role of mindfulness-based interventions on occupational distress and resilience among emergency nursing professionals.

Materials and methods

This study was a systematic review. The databases used for this review were PubMed and Scopus from 2018 to 2023. Interventional studies published in English that used mindfulness-based techniques among emergency and critical care nurses to alleviate their occupational distress and burnout and improve resilience were considered for review. This systematic review adheres to the PRISMA guidelines. The study was registered with PROSPERO (CRD42024512071).

Results

Ten studies were found to be eligible and included in this review. Out of the 10 studies included, nine studies demonstrated the improvement of psychological well-being, compassion, and resilience followed by the intervention.

Conclusion

The findings of this systematic review suggest that mindfulness-centered interventions can be an effective strategy to cope with distress and burnout and in building compassion and resilience among the healthcare professionals who are employed at the emergency and critical care department in a hospital.

Clinical significance

Incorporating mindfulness-based practices and interventions in healthcare settings, especially among critical care and emergency departments may help in ameliorating the professional well-being of the staff which may result in a resilient work environment and improvement in the quality of patient care.

How to cite this article

Joseph A, Jose TP. Coping with Distress and Building Resilience among Emergency Nurses: A Systematic Review of Mindfulness-based Interventions. Indian J Crit Care Med 2024;28(8):785-791.

Exploring the role of communication in effective nurse leadership and patient care

Nurses have to be aware of their personal responsibility to demonstrate effective leadership and thereby contribute to safe and effective patient care. One of the primary skills that nurses can use to become effective leaders is communication. This article explores how communication is a vital tool in enabling nurse leaders to motivate their team members and advocate for patients. The author details some of the essential communication skills that nurses require if they are to promote person-centred care and explores the often-neglected areas of non-verbal and written communication. By possessing a full range of communication skills, nurses can empower themselves to lead clinical teams and advocate for patients.

Experiences of the National Post-Exposure Prophylaxis Hotline (PEPline): Occupational PEP consultation needs and trends, 2014 to 2022

BACKGROUND

The National Clinician Consultation Center operates the Post-Exposure Prophylaxis Hotline (PEPline), a federally-funded educational resource providing bloodborne pathogen exposure management teleconsultation to US clinicians.

METHODS

Sixty-seven thousand one hundred nine occupational post-exposure prophylaxis (PEP) consultations (January 2014 to December 2022) were retrospectively analyzed to describe PEPline utilization and common inquiries addressed by National Clinician Consultation Center consultants.

RESULTS

Most calls involved percutaneous incidents (70%); blood was the most common body fluid discussed (60%). Inpatient units were the most common exposure setting (35%) and licensed nursing professionals were the most common category of exposed workers (28%). Of 2,295 calls where workers had already initiated PEP for human immunodeficiency virus (HIV) prevention and time to first dose was known, 9% had initiated HIV PEP within 2 hours of exposure; almost 80% had initiated HIV PEP between 2 and 24 hours; 3% after 24 to 36 hours; 5% after 36 to 72 hours; and 2% after 72 hours. Calls from urgent care providers increased by 10% over time. Overall, more than 90% of callers requested support on risk assessment, including source person testing; other common questions involved PEP side effects and follow-up care.

CONCLUSIONS

PEPline consultations can help raise awareness about PEP availability and timely initiation, and reduce stigma by addressing common misperceptions about bloodborne pathogen transmission mechanisms and likelihood, particularly regarding HIV.

When experiencing nice interactions at work: Good sleep quality via well-being

Based on the Work-Home Resources Model and Conservation of Resources Theory, we develop dual mechanisms by which nice interactions (patients' compliments and coworkers' informational support) predict sleep quality. Specifically, we expect these nice interactions to help individuals conserve their personal energy in the form of less cognitive depletion (a cognitive process) and diminished physical fatigue (a physical process). Further, we propose employees utilise their energy resources to experience better sleep quality. To test the proposed model, we utilised an experience-sampling method by recruiting 223 female nurses working in a regional university hospital in South Korea. Specifically, we measured nice interactions and personal resources at 3 PM on Day t and sleep quality at 5-6 AM on Day t + 1, and we administered the questionnaire for 10 consecutive days. Overall, after removing 79 invalid observations (not completing questionnaire in a timely manner), we had a final total of two-wave 1997 daily observations from 223 nurses. Receiving more compliments from patients and more information from coworkers positively affects nurses' cognitive energy (less cognitive depletion) and physical energy (less physical fatigue), which predicts better sleep quality. Finally, results supported indirect effects of these nice interactions on sleep quality via cognitive and physical processes.

Nurses' experiences of racism in mental health settings through patient and family interactions: A systematic review

Nursing staff engage readily with patients and associates in mental health/forensic inpatient settings. These settings are known to have instances of workplace violence directed towards staff and such violence includes racism. Racism is a form of workplace violence that must be better understood and supported within this complex setting. Completing a systematic review to coalesce preexisting research and suggested interventions can be beneficial to supporting nurses. Systematic review following PRISMA guidelines. CINAHL, PsycInfo, Medline, British Nursing Database and Web of Science databases were searched. Reviewers screened the papers for inclusion (29 articles out of 7146 were selected for inclusion) and completed the quality appraisal using the Mixed Methods Appraisal Tool. Subsequently, data extraction was completed, and findings were summarised through narrative synthesis. The way racism was conceptualised impacted how data was collected, reported and interpreted; racism was silenced or exposed depending on how studies were undertaken. If exposed, evidence indicates racism is a problem but is not always acknowledged or acted upon. Some evidence determined racism led to negative work-related outcomes. The literature provided limited examples of interventions. These included changing education/orientation for staff, openly discussing racist events and better planning for patients among colleagues and management. Increasing diversity within the workforce requires more research exploring and addressing issues related to racism towards nurses. Narratives of racism being normalised and embedded in mental health/forensic settings need to be challenged.

Workplace health culture and trust in the occupational health office: A descriptive study of meatpacking workers

INTRODUCTION

Worker trust in employer-provided occupational health services has not been explored in essential industries, such as meatpacking. The purpose of this study was to describe workplace health culture and trust in the occupational health office and highlight meatpacking workers' experiences with the occupational health office.

METHODS

Meatpacking workers were surveyed between February 2021 and October 2022. Descriptive statistics and nonparametric tests were used to explore trust across demographic variables, including workplace health culture. Thematic analysis was used to examine the short-answer qualitative data.

RESULTS

Among workers who completed surveys (n = 731), health culture was rated low (M = 1.3 (0.73); possible range 0-3). Trust in the occupational health office was also rated low (M = 8.2 (5.06); possible range 0-20). Workers' descriptions of interactions with the occupational health office were mostly unfavorable (287 negative opinion units; 97 positive opinion units) and primarily focused on quality of care, communication, the supervisor as gatekeeper to health services, and the prioritization of company interests.

CONCLUSION

Meatpacking worker health may be improved by building worker trust in the occupational health office. Suggested strategies include enhanced communication, protection of confidentiality, prioritization of worker well-being, and promotion of a stronger health culture in plants and throughout the industry. Supporting workers without a regular healthcare provider to establish a relationship with a primary care provider of their choice is also recommended.

Reducing Noise in the NICU

BACKGROUND

In the neonatal intensive care unit (NICU), elevated noise negatively impacts the neurodevelopmental environment, interrupts sleep, and can affect brain development in neonates. The American Academy of Pediatrics recommends that noise levels in the NICU should not exceed 45 dB.

PURPOSE

The project aims were to: (1) decrease average noise level by 10% from baseline and (2) decrease exposure to severe noise (>65 dB) to <5% of the time.

METHODS

This quality improvement project was conducted during 2021-2022 as a pre/post observational design in a Level IV NICU in New York City. We monitored sound levels for 20-24 h, 5 d/wk. Quality improvement interventions included: novel approaches to staff education, visual cues for when noise thresholds were exceeded, parent education, including access to personal decibel meters, technical improvements to vital sign monitors and entry doors, and defined quiet times (HUSH) for 2 h each 12-hour shift.

RESULTS

Education efforts and technical improvements successfully reduced median noise levels within the stepdown unit ( P < .001), though not in the acute care NICU. In contrast, the implementation of 2-hour periods of enforced "quiet time" every 12 h effectively reduced both median noise levels and the incidence of severe noise (>65 dB) in both locations.

IMPLICATIONS FOR PRACTICE AND RESEARCH

The HUSH strategy may be a sustainable way to decrease noise in the NICU. Future projects should prioritize education and dedicated quiet times to align with recommended standards, while research should explore the long-term developmental impacts of excessive noise levels on neonatal growth.

Protecting Frontline Workers: Strategies for Preventing and Mitigating Violence in the Emergency Department

Violence in the emergency department (ED) has been escalating for decades worldwide. High-stress situations are commonplace in the ED and can lead to intentional and unintentional aggression from patients. Staff must be educated on the signs of violence and escalation to recognize potentially dangerous situations early. Staff must also identify underlying medical conditions as the source of unintentional violence. Both situations would require different approaches to management. ED violence negatively affects patient care and leads to long-term harmful outcomes for staff. Multiple strategies for mitigation and prevention have been explored in the literature. Among those, weapon detection systems, de-escalation training, and violence prevention programs have demonstrated improved staff outcomes and decreased violence. Formalized procedures and policies should clearly assign roles for each staff member in the event of a violent patient. Training programs should be instituted and may include self-defense classes or crisis intervention courses. Emergency medicine residency programs and EDs around the country must address the rising incidence of violence within EDs through interdisciplinary policy, procedure development, and prevention and mitigation programs.

Blood Pressure Trends, Demographic Data, Workload, and Lifestyle Factors Among Nurses in the Subcarpathian Region of Poland: A Cross-Sectional Observational Study

BACKGROUND Hypertension is one of the main modifiable risk factors linked to cardiovascular disease and its prevalence is currently increasing in various age groups. This study aimed to evaluate blood pressure, demographic data, workload, and lifestyle factors in nurses employed in hospitals in the Subcarpathian region of southeastern Poland. MATERIAL AND METHODS This cross-sectional observational study was conducted among 627 professionally active nurses. Certified devices were used for measurements: body mass analyzer (Tanita MC-980 PLUS MA), automated sphygmomanometer (Welch Allyn 4200B), stadiometer (Seca 213), and tape measure (Seca 201). The frequency of consumption of specific product groups was assessed using a survey method. Analysis using R software (version 4.3.1) employed logistic regression to examine variables affecting hypertension occurrence. RESULTS The study found that elevated blood pressure is more prevalent among nurses than they self-report. Logistic regression analysis identified significant predictors for hypertension, including age (odds ratio; OR=1.061; OR=1.045), working more than 1 job (OR=1.579; OR=1.864), and body mass index (OR=1.152; OR=1.113). CONCLUSIONS Regular monitoring of blood pressure is necessary for early detection and timely intervention of hypertension. Enhancing nurses' awareness of their own health will encourage proactive preventive measures. Implementing comprehensive education programs focused on the latest advances in cardiovascular disease prevention is essential.

The Total Worker Health® (TWH) approach: a systematic review of its application in different occupational settings

BACKGROUND

The National Institute for Occupational Safety and Health (NIOSH), in 2011, developed the "Total Worker Health®" (TWH) as a holistic approach to protect and promote the workers' safety, health, and well-being. After over ten years from the TWH development, the aim of the present systematic review is to provide a comprehensive overview of the worldwide TWH initiatives.

METHODS

PubMed, Scopus and ISI Web of Science were searched for TWH studies published up to the 31st of July 2023, and 43 investigations could be included. The review was registered on the International prospective register of systematic reviews PROSPERO with the reference number CRD42023416972.

RESULTS

Issues that emerged as relevant for the TWH operationalization were the awareness about the TWH approach and fundamentals, the leadership commitment, and a participatory engagement of the workforce: these aspects all contributed to acceptable and effective setting oriented TWH plans, specifically tailored on the peculiarities of the workplace, including small enterprises and multiemployer worksites. Evaluation and continual improvement were reported as fundamental for the successful implementation of TWH initiatives. Limited resources for safety and health initiatives, in terms of time, people, and funds, together with difficulties in the identification of safety and health priorities and a poor participatory culture were recognized as obstacles to the TWH application. Training resulted the core component of the TWH leadership and workforce preparedness, with beneficial results in terms of safety culture and adoption of preventive measures.

CONCLUSIONS

Although interesting aspects emerged from our review, future longitudinal investigations should confirm the effectiveness, easy integration, and long-term sustainability of TWH models in different workplaces, in order to effectively support safe and health-enhancing works able to improve innovation and productivity.

The Chain-Mediating Effects of Mindfulness and Sense of Control on Corporate Employees' Mental Health Problems

Based on the chain-mediating role of mindfulness and sense of control, this study examines the mediating role of mindfulness and sense of control on employees' mental health. A total of 720 questionnaires were collected from employees of select enterprises and institutions in China; 53 invalid questionnaires were excluded, with a response rate of 93%, leaving 667 employees as the study sample (average age = 38 years, 71.8% female). The study findings show that: (1) Work-family conflict had a significant positive correlation with mental health problems and a significant negative correlation with mindfulness and sense of control. (2) The influence on the mental health state was due to the mediating effect of mindfulness, sense of control, and the chain-mediating effect of mindfulness and sense of control. The study adopted self-report scales for measuring mindfulness and a sense of control; therefore, further experimental methods must be included in the future to explore these results. This study shows that mindfulness and sense of control can reduce the impact of work-family conflict on mental health problems. Additionally, the chain-mediating effect of mindfulness and sense of control plays an important role in mental health problems.

Work-Related Fatigue Among Indonesian Offshore Oil and Gas Workers

BACKGROUND

Work-related fatigue, combined with shift work and prolonged work hours, has a significant effect, contributing to increasing accident rate by 50-100%.

AIMS

To assess the level of work-related fatigue over a 4-week work period among offshore rig oil and gas workers in Indonesia.

METHODS

This cohort study evaluated acute fatigue, chronic fatigue, and intershift recovery scores among offshore oil and gas rig workers using the Occupational Fatigue Exhaustion Recovery 15 (OFER15) questionnaire. Fatigue levels were assessed weekly throughout the study duration, which was 4-week work period. Additionally, at the fourth week, participants were asked about psychosocial factors that could be potentially related to fatigue.

RESULTS

Of 67 participants, the average scores of acute and chronic fatigue were 30.0 and 33.3, and the scores had significantly increased over 4 weeks (P < 0.001). The intershift recovery scores statistically significantly decreased over 4 weeks (P < 0.001), and the differences between weeks (Week 1 versus 2, Week 1 versus 3 and Week 1 versus 4) were also statistically significant (P < 0.001). Acute and chronic fatigue scores had a significant positive correlation with psychological job demands and negatively correlated with influence at work and job satisfaction. Over 4 weeks, acute fatigue augmented chronic fatigue, while acute and chronic fatigue demanded a longer recovery.

CONCLUSIONS

Workers at the offshore rig experienced work fatigue during their on-duty periods, with the level of fatigue significantly increasing over the 4 weeks. Comprehensive fatigue management at offshore rigs is vital to mitigate work fatigue and minimize the risk of work-related accidents.

Predicting depression in patients with heart failure based on a stacking model

BACKGROUND

There is a lack of literature discussing the utilization of the stacking ensemble algorithm for predicting depression in patients with heart failure (HF).

AIM

To create a stacking model for predicting depression in patients with HF.

METHODS

This study analyzed data on 1084 HF patients from the National Health and Nutrition Examination Survey database spanning from 2005 to 2018. Through univariate analysis and the use of an artificial neural network algorithm, predictors significantly linked to depression were identified. These predictors were utilized to create a stacking model employing tree-based learners. The performances of both the individual models and the stacking model were assessed by using the test dataset. Furthermore, the SHapley additive exPlanations (SHAP) model was applied to interpret the stacking model.

RESULTS

The models included five predictors. Among these models, the stacking model demonstrated the highest performance, achieving an area under the curve of 0.77 (95%CI: 0.71-0.84), a sensitivity of 0.71, and a specificity of 0.68. The calibration curve supported the reliability of the models, and decision curve analysis confirmed their clinical value. The SHAP plot demonstrated that age had the most significant impact on the stacking model's output.

CONCLUSION

The stacking model demonstrated strong predictive performance. Clinicians can utilize this model to identify high-risk depression patients with HF, thus enabling early provision of psychological interventions.

Making room for occupational health nursing in Nanda‐I: “Impaired foot health” as a diagnosis

OBJECTIVE

Discuss the label "impaired foot health" to be considered a problem-focused nursing diagnosis according to the taxonomy of NANDA-I.

METHODS

Discussion article based on literature reviews and observational studies based on the authors' PhD ongoing research about foot health among nursing students and professionals.

FINDINGS

Attending to the definition of nursing diagnosis and the scope of nursing practice internationally, several human responses and contexts should be considered, opening new opportunities for NANDA-I completeness.

CONCLUSIONS

A new nursing diagnosis has been disclosed, opening new dimensions to the NANDA-I taxonomy.

IMPLICATIONS FOR NURSING

This nursing diagnosis represents an opening door for the taxonomy, particularly for occupational health nursing in an international context.

[DNVF Memorandum: Objectives and Methods of Physical Activity-Related Health Services Research]

The DNVF Memorandum: Objectives and Methods of Physical Activity-Related Health Services Research summarizes, for the first time, the highly interdisciplinary and interprofessional field of physical activity-based health care in the German healthcare system. In addition to providing a conceptual framework and definition of key measures and concepts in physical activity-related health care research, existing research gaps and needs are identified, and methods for advancing this relatively young field of research are described. A particular focus of this study is the relevant outcome parameters and their standardized assessment using established and valid measurement tools. The memorandum aims to establish a general understanding of the complex subject of promoting physical activity and sports therapy in the context of healthcare, to give an impulse to new research initiatives, and to integrate the currently available strong evidence on the effectiveness of physical activity and exercise into healthcare.

Spotlight on nurses' smoking prevalence and addiction in Istanbul, Türkiye, the leading country in the implementation of WHO MPOWER policies

OBJECTIVE

Türkiye is the leading country that has been applying the MPOWER criteria of the World Health Organization for years. However, the prevalence of smoking among nurses appears to be high, according to the literature. Therefore, we aimed to determine the prevalence, addiction levels, and dynamics of tobacco smoking among nurses in Türkiye.

METHOD

In this descriptive cross-sectional study, a questionnaire (prepared in cooperation with the "World Health Organization") and the Fagerström Test for Nicotine Dependence were administered to 529 nurses working at a tertiary-care university hospital in 2020. Logistic regression was performed to determine factors predicting smoking.

RESULTS

The prevalence of smoking among nurses was 32.7% (n = 173). The mean Fagerström test score indicated a "low dependence" level (score: 3 ± 2.6). Both results were higher for males. A relationship was found between trying smoking cigarette and hookah. Of the "current smokers" group, 102 (60.4%) stated that they wanted to quit smoking. Only 21 (27.6%) of the nurses who have tried to quit smoking thus far have received professional help.

CONCLUSION

The prevalence of smoking among nurses working at a tertiary-care university hospital was relatively low compared to that among nurses in Türkiye. While females are normally expected to smoke less, the high prevalence of smoking among nurses (most of them female) raises the question of the professional basis of this situation. However, the low rate of receiving professional help reveals the lack of promotion and accessibility of smoking cessation outpatient clinics in the faculty environment. Finally, the perception that hookah is an alternative tobacco product leads to cigarette smoking. The good news was that nurses had a low dependency rate.

Work-related slip, trip and fall injuries reported by National Health Service staff in Great Britain: how many are due to slipping?

BACKGROUND

Workplace injuries due to a slip, trip or fall on the level (STF) are often reported together, making the potential impact of targeted interventions, such as slip-resistant footwear, difficult to assess. The objective of this research was to review workplace non-fatal injuries reported as STFs under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 to determine what proportion of staff STF injuries reported by the National Health Service (NHS) in Great Britain were caused specifically by a slip.

METHODS

The free text descriptions of all 1004 STF injuries reported by NHS staff in summer 2018 and winter 2018/2019 were independently reviewed by two researchers to determine whether a slip was the primary cause or not. Where agreement could not be reached or the cause was unclear, an STF specialist reviewed the reports to establish the likely cause. The kappa statistic was used to measure inter-reviewer agreement, and the χ2 test was used to compare proportions across seasons.

RESULTS

The reviewers agreed on the initiating event, slip or non-slip, for 917 (91.3%) of the incidents. The kappa statistic was 0.842 (95% CI 0.785 to 0.898) indicating strong agreement between reviewers. In total, 431 or 42.9% (95% CI 39.8% to 46.1%) of the STF incidents were slips. This percentage was greater in winter compared with summer (49.0% and 36.0%, respectively, p<0.001).

CONCLUSION

The high proportion of slips among reported STF injuries implies that an effective intervention targeting workplace slips in the NHS could have a substantial impact on the number of injuries reported.

The artistic image processing for visual healing in smart city

This study investigates the processing methods of artistic images within the context of Smart city (SC) initiatives, focusing on the visual healing effects of artistic image processing to enhance urban residents' mental health and quality of life. Firstly, it examines the role of artistic image processing techniques in visual healing. Secondly, deep learning technology is introduced and improved, proposing the overlapping segmentation vision transformer (OSViT) for image blocks, and further integrating the bidirectional long short-term memory (BiLSTM) algorithm. An innovative artistic image processing and classification recognition model based on OSViT-BiLSTM is then constructed. Finally, the visual healing effect of the processed art images in different scenes is analyzed. The results demonstrate that the proposed model achieves a classification recognition accuracy of 92.9% for art images, which is at least 6.9% higher than that of other existing model algorithms. Additionally, over 90% of users report satisfaction with the visual healing effects of the artistic images. Therefore, it is found that the proposed model can accurately identify artistic images, enhance their beauty and artistry, and improve the visual healing effect. This study provides an experimental reference for incorporating visual healing into SC initiatives.

Beyond the gender binary: a survey of gender marginalization and social boundaries in Australian jazz and improvisation

Jazz and improvisation have typically been associated with ideals of freedom and liberty; however, in practice these genres are known to be constrained by entrenched patterns of male domination and gender discrimination. Despite a large number of qualitative accounts evidencing persistent sexism and gender exclusion in the field, there exists a lack of empirical data to assess the scale of this phenomenon and substantiate smaller-scale research on gender inequality. In this paper, we employ boundary theory to report on a quantitative investigation of gender marginalization in jazz and improvisation in the Australian context, positioning gender as a symbolic boundary resulting in the social exclusion and marginalization of gender diverse individuals and women. An anonymous survey (n=124) was run over a period of five months, to explore the beliefs, attitudes, and experiences concerning gender, of people participating in Australian jazz and improvisation. A means comparison found that gender was a statistically significant indicator (p ≤0.05) on almost all measures, with gender diverse respondents significantly more likely to report the effects of marginalization than their (cisgender) counterparts. Additionally, the results indicated contrasting forms of musical engagement and marginalization across gender groups, with women perceiving exclusion to a lesser extent than gender diverse practitioners, and differing in their opinions regarding work opportunities. Lastly, a widespread but historically unspoken awareness of sexual harassment in the Australian jazz and improvisation industry was reported by all genders. This paper concludes with three recommendations for future research, policy and practice: 1. Specific targeted strategies are needed to address the manifold and complex forms of marginalization experienced by gender diverse people; 2. Heightened institutional visibility for marginalized groups is needed to change gendered narratives and highlight awareness of inequities; and 3. Enhanced safety measures are critically needed to address sexual harassment throughout the industry.

Teleworking: does it make workers healthier and productive? A cross-sectional study on a Southern European population

BACKGROUND

Teleworking (TW) has recently shifted from a marginal into a common practice. Yet, concerns have been raised regarding potential work-health negative effects, related to the reduced socialization, and extended working hours with computers at home, possibly offset by reduced commuting time or better individual work-life balance. This paper aims at describing the influence of TW on health, well-being, and productivity perceptions, and how this is shaped by TW conditions.

METHODS

We collected data from workers of 25 companies that exert their activity in Portugal. Data were completed with a representative sample of workers who regularly participate in surveys (total N = 1,069). We applied an on-line questionnaire from September the 1st 2022 to December the 1st 2022. We performed a simple descriptive analysis of each variable. Then, we analyzed the relationship between TW conditions and self-reported health, and between TW conditions at home and productivity, using logistic regression models.

RESULTS

We observed a high prevalence of self-perceived health worsening (15.9%), mostly among those with poor TW conditions. Most teleworkers enjoyed favorable TW conditions, despite limited company support. Relevant changes were observed in lifestyle factors, towards more smoking (5.5%), alcohol drinking (4.5%), and worse diet (10.1%). Two thirds reported enhanced productivity. A statistically significant relationship was observed between inadequate TW conditions, health deterioration, and lower productivity. A 6.0% point (pp) increased risk of productivity worsening was observed when employees faced at least one inadequate condition at home (no private working place at home, inadequate heating, artificial light, or absence of well-being at home). The risk of health deterioration increased by 12.9 pp when facing at least one of these inadequate conditions, and by 6.3 under hybrid TW, compared to one or two days of TW.

CONCLUSIONS

Most teleworkers highlighted a positive perspective about teleworking. Yet, TW conditions are not favorable for all workers, with consequences on health, well-being, and productivity, suggesting that further support is needed for teleworkers to protect their health at home, and reach its maximum benefit.

Sharps injuries among healthcare workers in Liberia and Ghana: a cross-sectional survey

There are little data on sharps injuries among healthcare workers in West Africa despite the region's high rate of hepatitis B and human immunodeficiency virus. The purpose of this study is to investigate healthcare workers' history of sharps injuries in Liberia and Ghana. An electronic cross-sectional survey was conducted among healthcare workers in Liberia and Ghana from February to June 2022. A link to the survey was texted to participants through professional association membership lists, including nursing, midwifery, and physician assistant organizations in both Liberia and Ghana and a physician organization in Ghana only. Five hundred and nine participants reported an average of 1.8 injuries per year in Liberia and 1.1 in Ghana (P ≤ .01); 15.1% of healthcare workers reported three or more injuries in the past year. Liberia had a higher proportion of frequently injured workers (P = .01). Frequently injured workers were evenly distributed across worker types. Workers in this region are vulnerable to sharps injuries. A frequently injured subset of workers likely has distinctive risk factors and would benefit from further investigation and intervention.

Occupational noise-induced hearing loss among dental personnel: a scoping review

Introduction Dental personnel are being exposed to noisy equipment on a daily basis and there are indications that dental professionals are at a higher risk of developing occupational noise-induced hearing loss (NIHL). Therefore, this study aims to assess the available research on NIHL among dental professionals.Methods A total of 452 publications were identified through searches on PubMed and Web of Science. These studies were screened on title and abstract for studies that investigated NIHL among dental professionals using objective or subjective parameters for hearing loss. The remaining publications were then searched for relevant data, such as research type, parameters used for measuring hearing loss and authors' conclusions.Results In total, 28 publications were finally included in the selection. Of this selection, 23 used objective criteria for NIHL, three used subjective criteria and two used both. From the 12 studies with objective measurements that also included a control group in their studies, eight reported a significant higher hearing loss among dental personnel than in the control groups. From the 13 studies with objective measurement without a control group, seven reported significant hearing loss among dental personnel. All five studies with subjective measurements reported significant hearing loss in dental personnel.Conclusions Hearing loss seems to be more prevalent among dental personnel than in most control groups.

Healthcare workers' views on type 2 diabetes mellitus management at selected clinics in Mthatha

BACKGROUND

 Diabetes is a non-communicable disease of global public health importance. Healthcare workers play a vital role in the management of this disease.

AIM

 This study aimed to explore healthcare workers' views on managing patients with type 2 diabetes at primary health care facilities.

SETTING

 The study was conducted at two primary health care facilities in Mthatha, South Africa.

METHODS

 This exploratory descriptive qualitative study included 28 primary health care workers. Data were collected through individual interviews and focus group discussions and analysed using a thematic analysis approach.

RESULTS

 Study participants' views of poor control of type 2 diabetes mellitus were categorised under patient- and healthcare system-related factors. The patient-related factors included poor adherence to an ideal diabetic diet, poor medication adherence, a lack of personal glucometers, and dearth of support systems. The healthcare system-related factors identified were inadequate patient education, long waiting times at the health facilities, high patient volumes, limited resources, and delayed service provision. Proposed solutions to address poor control of diabetes included improving patient health education, providing diabetic patients with glucometers, multi-stakeholder management of diabetes, allocating designated areas for patients with chronic illnesses, improved resource allocation, and regular staff training.

CONCLUSION

 Study participants perceived an improved level of control of diabetes among patients managed at the Community Health Centres. When designing interventions for the management of diabetes, both patient and healthcare system-related factors and the proposed solutions should be considered.Contribution: This study's findings could promote better management of diabetes at the primary health care level.

Lifestyle factors and their relative contributions to longitudinal progression of cardio-renal-metabolic multimorbidity: a prospective cohort study

BACKGROUND

The role of lifestyle factors and their relative contributions to the development and mortality of cardio-renal-metabolic multimorbidity (CRMM) remains unclear.

METHODS

A study was conducted with 357,554 UK Biobank participants. CRMM was defined as the coexistence of two or three cardio-renal-metabolic diseases (CRMDs), including cardiovascular disease (CVD), type 2 diabetes (T2D) and chronic kidney disease (CKD). The prospective study examined the associations of individual and combined lifestyle scores (diet, alcohol consumption, smoking, physical activity, sedentary behavior, sleep duration and social connection) with longitudinal progression from healthy to first cardio-renal-metabolic disease (FCRMD), then to CRMM, and ultimately to death, using a multistate model. Subsequently, quantile G-computation was employed to assess the relative contribution of each lifestyle factor.

RESULTS

During a median follow-up of 13.62 years, lifestyle played crucial role in all transitions from healthy to FCRMD, then to CRMM, and ultimately to death. The hazard ratios (95% CIs) per score increase were 0.91 (0.90, 0.91) and 0.90 (0.89, 0.91) for healthy to FCRMD, and for FCRMD to CRMM, and 0.84 (0.83, 0.86), 0.87 (0.86, 0.89), and 0.90 (0.88, 0.93) for mortality risk from healthy, FCRMD, and CRMM, respectively. Among the seven factors, smoking status contributed to high proportions for the whole disease progression, accounting for 19.88-38.10%. High-risk diet contributed the largest proportion to the risk of transition from FCRMD to CRMM, with 22.53%. Less-frequent social connection contributed the largest proportion to the risk of transition from FCRMD to death, with 28.81%. When we further consider the disease-specific transitions, we find that lifestyle scores had slightly stronger associations with development to T2D than to CVD or CKD.

CONCLUSIONS

Our study indicates that a healthy lifestyle may have a protective effect throughout the longitudinal progression of CRMM, informing more effective management and treatment. Smoking status, diet, and social connection played pivotal roles in specific disease transitions.