Florentino Serranheira

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

BACKGROUND Hospital work-related musculoskeletal disorders (WRMSDs) symptoms are highly prevalent and nurses are considered the health care professional group more often affected by WRMSDs. OBJECTIVES Understanding the effects of nursing tasks on WRMSDs symptoms. METHODS Portuguese 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. RESULTS Hospital 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. CONCLUSIONS Tasks 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.

LER/DORT: que métodos de avaliação do risco?

O processo de selecao dos metodos observacionais de avaliacao do risco de LER/DORT e complexo, mas fundamental para a gestao do risco. Em Setubal, no periodo de 2004 a 2005, numa empresa portuguesa da industria automobilistica, onde a avaliacao do risco foi previamente efetuada, reaplicou-se o metodo OCRA checklist (avaliacao do risco de LER/DORT ao nivel dos membros superiores) em postos de trabalho (n=152) - montagem final e pintura - classificados de risco moderado/elevado (OCRA >16,5). Nas situacoes em que se reconfirmou a presenca de risco (n=71), aplicaram-se tres outros metodos: RULA, SI e HAL. Registraram-se sequencias em video da atividade de trabalho para avaliar a validade preditiva dos metodos. Revelam-se divergencias entre os metodos na classificacao dos postos de trabalho de risco elevado: OCRA - 34 postos; HAL - 35 postos; SI - 31 postos; RULA - 7 postos. A analise do efeito de cada variavel independente (fator de risco) nos scores finais dos metodos (regressao linear multivariada) revela distintos contributos e processos de ponderacao/avaliacao do risco de LER/DORT. A analise dos registros em video evidencia diversas validades preditivas relativamente aos fatores de risco integrantes dos metodos aplicados. Os resultados indicam a necessidade de uma selecao do metodo de avaliacao do risco de LER/DORT adequada a cada situacao (real) de trabalho, baseada no maior conhecimento dos metodos.

Evaluation of exposure parameters in plain radiography: a comparative study with European guidelines

Typical distribution of exposure parameters in plain radiography is unknown in Portugal. This study aims to identify exposure parameters that are being used in plain radiography in the Lisbon area and to compare the collected data with European references [Commission of European Communities (CEC) guidelines]. The results show that in four examinations (skull, chest, lumbar spine and pelvis), there is a strong tendency of using exposure times above the European recommendation. The X-ray tube potential values (in kV) are below the recommended values from CEC guidelines. This study shows that at a local level (Lisbon region), radiographic practice does not comply with CEC guidelines concerning exposure techniques. Further national/local studies are recommended with the objective to improve exposure optimisation and technical procedures in plain radiography. This study also suggests the need to establish national/local diagnostic reference levels and to proceed to effective measurements for exposure optimisation.

Estratégia de avaliação do risco de lesões músculo-esqueléticas de membros superiores ligadas ao trabalho aplicada na indústria de abate e desmancha de carne em Portugal

BACKGROUND: Work-related Musculoskeletal Disorders (WRMSD) are common occupational diseases. The present study aims at examining an integrated perspective of risk assessment and health surveillance at a meatpacking plant. METHODS: The strategy adopted was of obtaining information about WRMSDs awareness at all workstations and from all their workers. This was based on: (i) questionnaire application - an adaptation of the Nordic musculoskeletal questionnaire, including a biomechanical item, (ii) WRMSDs clinical protocol (iii) RSI risk filter and Strain Index application, (iv) instrumentation with electrogoniometry and force sensors at previously classified as high risk workstations. RESULTS: WRMSDs signs and symptoms mainly in wrist/hands (n=27) and in lumbar region (n=32) were identified. Results revealed an important prevalence of WRULMSDs associated to meatpacking industry activities (30%) and high risk scores based on Strain Index (n=26 Right UL; n=7 Left UL). Instrumentation showed details of recurrency, of postures and of force, which can be used for intervention. CONCLUSIONS: Its necessary to develop ergonomic strategies and approaches on WRMSDs prevention (risk assessment and management) that will lead to changes on workstations and working processes.

Mammography equipment design: impact on radiographers’ practice

AbstractObjectivesIdentify radiographers’ postures during frequent mammography procedures related to the mammography equipment and patient characteristics.MethodsA postural task analysis was performed using images acquired during the simulation of mammography positioning procedures. Simulations included craniocaudal/(CC) and mediolateral-oblique/(MLO) positioning in three different settings: radiographers and patients with similar statures, radiographers smaller than the patients and radiographers taller than the patients. Measurements of postural angles were performed by two raters using adequate software and classified according to the European Standard EN1005-4:2005 + A1:2008.ResultsThe simulations revealed that the most awkward posture in mammography is during the positioning of MLO projection in short-stature patients. Postures identified as causing work-related musculoskeletal disorder (WRMSD) risk were neck extension, arms elevated and the back stooped, presenting angles of 87.2, 118.6 and 63.6, respectively. If radiographers were taller than patients, then the trunk and arm postures were not acceptable.ConclusionsWorking in a mammography room leads to awkward postures that can have an impact on radiographers’ health, namely WRMSDs. The results in this study showed that there are non-acceptable postures associated with frequent working procedures in mammography. MLO is the most demanding procedure for radiographer postures and may be related to WRMSDs. Mammography devices should be redesigned considering adjustability for radiographers.Main Messages• Mammography constraints for radiographers in mammography procedures have not been well studied. • Performing mammography leads to awkward postures that can impact radiographers’ health. • MLO, the most demanding procedure for radiographers, is possibly related to WRMSDs.

Patient and hospital characteristics that influence incidence of adverse events in acute public hospitals in Portugal: a retrospective cohort study

Abstract Objective To analyse the variation in the rate of adverse events (AEs) between acute hospitals and explore the extent to which some patients and hospital characteristics influence the differences in the rates of AEs. Design Retrospective cohort study. Chi-square test for independence and binary logistic regression models were used to identify the potential association of some patients and hospital characteristics with AEs. Setting Nine acute Portuguese public hospital centres. Participants A random sample of 4250 charts, representative of around 180 000 hospital admissions in 2013, was analysed. Intervention To measure adverse events based on chart review. Main Outcome Measure Rate of AEs. Results Main results: (i) AE incidence was 12.5%; (ii) 66.4% of all AEs were related to Hospital-Acquired Infection and surgical procedures; (iii) patient characteristics such as sex (female 11%; male 14.4%), age (≥65 y 16.4%; <65 y 8.5%), admission coded as elective vs. urgent (8.6% vs. 14.6%) and medical vs. surgical Diagnosis Related Group code (13.4% vs. 11.7%), all with p < 0.001, were associated with a greater occurrence of AEs. (iv) hospital characteristics such as use of reporting system (13.2% vs. 7.1%), being accredited (13.7% vs. non-accredited 11.2%), university status (15.9% vs. non-university 10.9%) and hospital size (small 12.9%; medium 9.3%; large 14.3%), all with p < 0.001, seem to be associated with a higher rate of AEs. Conclusions We identified some patient and hospital characteristics that might influence the rate of AEs. Based on these results, more adequate solutions to improve patient safety can be defined.

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.

Exigências visuais e fadiga visual em médicos oftalmologistas

Background Visual demands, especially for near vision, are becoming increasingly more frequent at the workplace, and might cause visual fatigue or asthenopia. The tasks performed by ophthalmologists involve visual effort, raising interest in their study within the context of occupational health. Objectives To estimate the prevalence of visual complaints and its relationship to work demands among ophthalmologists at a university hospital in Lisbon. Methods Occurrence of visual fatigue symptoms was assessed by means of a symptom questionnaire - College of Optometrists in Vision Development Quality of Life (COVD-QoL) - and through the identification of near points of accommodation and convergence. Schirmers test was used to assess tear production. The results were analyzed by means of descriptive statistics, Spearmans coefficient and the Wilcoxon test for p<0.05. Results Most among the 27 analyzed physicians reported visual fatigue (n=25), dry eyes and frequent blinking (n=27). Schirmers test evidenced differences at the end of the working day and the near points of accommodation and convergence indicated occurrence of visual fatigue. Conclusions The results showed significant differences between the beginning and the end of the working day among ophthalmologists, with occurrence of visual fatigue at the end of the working day. These findings point to the need to implement a health surveillance program to prevent occupational visual disorders.Background Visual demands, especially for near vision, are becoming increasingly more frequent at the workplace, and might cause visual fatigue or asthenopia. The tasks performed by ophthalmologists involve visual effort, raising interest in their study within the context of occupational health. Objectives To estimate the prevalence of visual complaints and its relationship to work demands among ophthalmologists at a university hospital in Lisbon. Methods Occurrence of visual fatigue symptoms was assessed by means of a symptom questionnaire - College of Optometrists in Vision Development Quality of Life (COVD-QoL) - and through the identification of near points of accommodation and convergence. Schirmers test was used to assess tear production. The results were analyzed by means of descriptive statistics, Spearmans coefficient and the Wilcoxon test for p<0.05. Results Most among the 27 analyzed physicians reported visual fatigue (n=25), dry eyes and frequent blinking (n=27). Schirmers test evidenced differences at the end of the working day and the near points of accommodation and convergence indicated occurrence of visual fatigue. Conclusions The results showed significant differences between the beginning and the end of the working day among ophthalmologists, with occurrence of visual fatigue at the end of the working day. These findings point to the need to implement a health surveillance program to prevent occupational visual disorders.

An analysis on neck and upper limb musculoskeletal symptoms in Portuguese automotive assembly line workers

Assembly lines are related to health risks and work-related musculoskeletal disorders (WMSD), particularly of the neck and upper limbs (WULMSD). The assessment of perceived musculoskeletal symptoms is essential to WULMSD prevention, but studies in this field are lacking. A cross sectional survey on assembly line workers (n=270) was performed. The objective of this study was to analyze the frequency and distribution of upper limb musculoskeletal symptoms in assembly line workers. Participants were predominantly men, with ages between 30 and 40 years. Neck and upper limbs pain/discomfort were the most reported symptoms (35.9%), with intensity predominantly moderate or severe. General Health Status and past musculoskeletal injury were the variables more related to the existence of musculoskeletal symptoms; longer working life in the same company, as under 5 years, were related to higher intensity of symptoms. An early identification of musculoskeletal symptoms and health surveillance over time is of most importance to develop WRULMSD prevention measures.