António Sousa-Uva

Nurses’ working tasks and MSDs back symptoms: results from a national survey

Healthcare workers, namely registered nurses (RN), are frequently exposed to work-related musculoskeletal disorders (WRMSDs) risk factors. Identifying the symptoms of these disorders is one of the first epidemiological steps to managing them. This study aims to identify WRMSDs prevalence symptoms in Portuguese RN. During 8 months (2010-2011) the National Public Health School and the Portuguese Registered Nurses Board made a call to all RN to answer an online WRMSDs questionnaire. Respondents (n=2140) are mostly females (77.4%) and work mainly in hospitals (n=1396) and in primary healthcare centers (n=421). Results show high symptoms prevalence (last 12 months) in the lower back (60.6%), the upper back (44.5%), and the neck (48.6%). Nurses activity, especially patient hygiene in bed, is a strong contributor (p>0.05) to pain in the upper back (OR=1.39 [1.09-1.80]) and lower back (OR=1.4 [1.08-1.84]). Patient holdup without mechanical support has the highest relationship (p>0.05) between work tasks and symptoms in the last 12 months in the upper back (OR=1.50 [1.19-1.90]). Prevalence rates of WRMSDs symptoms in Portuguese nurses are no different from other studies with Swedish, Italian and Greek nurses. Maybe changes in healthcare systems didnt change the way care is delivered and we must rethink how to prevent nurses WRMSDs.

Hospital nurses tasks and work-related musculoskeletal disorders symptoms: A detailed analysis

BACKGROUNDnHospital work-related musculoskeletal disorders (WRMSDs) symptoms are highly prevalent and nurses are considered the health care professional group more often affected by WRMSDs.nnnOBJECTIVESnUnderstanding the effects of nursing tasks on WRMSDs symptoms.nnnMETHODSnPortuguese nurses answered to a modified Nordic Musculoskeletal symptoms Questionnaire. The increased likelihood of having WRMSDs symptoms was estimated from a daily working task schedule and the probability of suffering from lumbar WRMSDs symptoms intensity was also estimated.nnnRESULTSnHospital nurses studied (n= 1.396) were mainly females (75.8%), and most of them reported more than 1 symptom (88%). Low-back pain was the most prevalent complaint (60.9%). Tasks performed more than 10 times a day, such as invasive procedures (OR = 2.142); care of hygiene and patient comfort in bed (OR = 2.484); patient mobilization in bed (OR = 2.022); and patient feeding (OR = 2.186) had an effect on dorsal and lumbar symptoms (p< 0.05).Those tasks involving invasive procedures were just the only ones producing symptoms simultaneously on every studied body part, such as lumbar, dorsal, wrist/hand and ankles/feet areas.nnnCONCLUSIONSnTasks with a greater effect on low-back pain intensity were patient bed feeding and patient hygiene and care. We found, when analysing simultaneously the effects of every task on the likelihood of having low-back symptoms, that involving invasive procedures were that only ones affecting simultaneously the presence of almost all WRMSDs symptoms studied.

Endemic methicillin-resistant Staphylococcus aureus: Nurses' risk perceptions and attitudes.

Dissemination of methicillin-resistant Staphylococcus aureus (MRSA) remains one of the most difficult challenges for prevention, control, and treatment of health care-associated infections. A survey and interviews were conducted on nurses from a hospital center. We found that most nurses perceived risk of acquiring MRSA related to themselves (72%), other nurses (88.5%), and patients (97.8%). This perception influences attitudes, leading to compliance with the existing recommendations.

The importance of protection glasses during neuroangiographies: A study on radiation exposure at the lens of the primary operator:

Background In interventional neuroradiology, few operators routinely use radiation protection glasses. Moreover, in most centers, radiation dose data only accounts for whole body dose without specific information on lens dose. In 2012, the International Commission on Radiological Protection advised that the threshold limit value for the lens should be 20u2009mSv/year instead of the previous 150u2009mSv/year limit. The purpose of this study was to compare the radiation dose in the operator’s lens during real diagnostic and interventional neuroangiographies, either using or without lead protection glasses. Methods Using the Educational Direct Dosimeter (EDD30 dosimeter), accumulated radiation dose in the lens was measured in 13 neuroangiographies: seven diagnostic and six interventional. Operators with and without radiation protection glasses were included and the sensor was placed near their left eye, closest to the radiation beam. Results Without glasses, the corrected mean dose of radiation in the lens was 8.02u2009µSv for diagnostic procedures and 168.57u2009µSv for interventional procedures. Using glasses, these values were reduced to 1.74u2009µSv and 33.24u2009µSv, respectively. Conclusion Considering 20u2009mSv as the suggested annual limit of equivalent dose in the lens, neuroradiologists may perform up to 2,494 diagnostic procedures per year without protecting glasses, a number that increases to 11,494 when glasses are used consistently. Regarding intervention, a maximum of 119 procedures per year is advised if glasses are not used, whereas up to 602 procedures/year may be performed using this protection. Therefore, neuroradiologists should always wear radiation protection glasses.

Antibody response to the influenza vaccine in healthcare workers

People vaccinated against influenza develop hemagglutination inhibition (HAI) antibodies (Ab) that bind to the virus and neutralize it. Ab titer levels are variable depending on factors insufficiently studied, and tend to decrease over time. In the present study, we analyzed antibodies responses before and after influenza vaccination in nurses working in a hospital, with the aim of: - identifying seroconversion rates to trivalent influenza vaccine one month after immunization; - evaluating if, six months after vaccination, influenza HAI Ab titer fall comparing to one-month post vaccination HAI Ab titer; - studying the association between the lack of HAI Ab response (seroconversion) assessed one month after immunization and: ◦ past influenza vaccinations, ◦ baseline (before vaccination) HAI Ab titer, ◦ baseline (before vaccination) HAI Ab titer ≥ 40 (considered as a protection titer). Hemagglutination inhibition reaction was used to assess specific HAI Ab titers against influenza A(H(1)N(1)), A(H(3)N(2)) and B virus strains included in the influenza vaccine and we used progressive dilutions of two times, starting on 1:10 until 1:20.480. Seroconversion rates, one month after vaccination, were 66.7% for A(H(1)N(1)) strain, 63.2% for A(H(3)N(2)) strain and 56.3% for B strain. The most immunogenic strain used in 2007/08 influenza vaccine was A(H(1)N(1)). Seroconversion rates after one month were negatively associated with past influenza vaccinations, baseline HAI Ab titers ≥ 40 and baseline HAI Ab titers. Six months after vaccination, 50% of participants showed a drop in HAI Ab titers to an half, for each of the considered strains, but they remain high enough to protect against the disease.

Occupational low-back pain in hospital nurses

A survey of hospital staff nurses of a large tertiary care hospital was performed to investigate occupational low-back pain. Attack rates of 41% (37% occupational) and 52% (occupational) were found using recall periods of two weeks and six months, respectively. Comparison with a control group suggests the validity of the work-relatedness of low-back pain in nurses. Factors associated with the disorder were also investigated, with results showing no differences due to nursing division assignment but significant association with specific tasks.

Biological Hazards for Healthcare Workers: Occupational Exposure to Vancomycin-Resistant Staphylococcus aureus as an Example of a New Challenge

Infections are among the most important occupational risks for healthcare workers. Some infections can be prevented through vaccination but, in other cases, there are no vaccines to prevent them, as happens with infections from antimicrobial-resistant organisms. Precautions related with transmission route and contact isolation or respiratory isolation are very important in order to protect healthcare workers and other patients. In this paper, the authors reviewed biological hazards for healthcare workers and described the procedures undertaken by an occupational health department (OHD) of a Portuguese hospital where vancomycin-resistant Staphylococcus aureus (VRSA) was isolated from a patient, for the first time in Europe. After the VRSA strain isolation, healthcare workers were instructed to adopt contact preventive measures. Nasal swabs were cultured weekly in 33 healthcare workers for several weeks until the patients’ culture changed to negative. In the meantime, OHD prepared actions to adopt in case of VRSA colonization or infection in healthcare workers.

Tendinite do manguito rotador em operadores de caixa de supermercado: contributos para a vigilância de saúde

| Background: Rotator cuff tendinitis (RCT) is common among supermarket cashiers due to their work demands. Repetitive movements of shoulder abduction and flexion are frequent, which might cause inflammation of the periarticular tissues of the shoulder, triggering signs and symptoms of RCT. Objectives: To investigate the prevalence of RCT in supermarket cashiers by means of assessment of symptoms, signs and ultrasound. Methods: Forty-four workers aged 28 to 47 years old participated in the study. The participants were subjected to a self-report shoulder complaints questionnaire, clinical examinations (“painful arc test”, “empty can test” and “Hawkins-Kennedy impingement test”) and soft tissue ultrasound. Results: A total of 26 participants reported shoulder pain on the right side (59.1%) and 16 (36.4%) on the left side. During clinical assessment, 15 and 11 workers (34.1% right and 25.0% left, respectively) had positive results on all three tests. Ultrasound showed alterations in the right and left shoulder in 16 and 17 participants (36.4 and 38.6%, respectively). No statistical correlation was found between the three approaches. The “empty can test” exhibited strong correlation with shoulder pain (χ2 Wald (1)=7.260, p=0.007). Similar results were obtained for the association between this test and ultrasound (χ2 Wald (1)=6.854, p=0.009, ROC=0.714, sensitivity 75%, specificity 67.9%). Conclusions: The results suggest that the “empty can test” is predictive of RCT in the medical surveillance of supermarket cashiers. This finding should be verified in future studies, especially with larger samples.