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PeerJ 2024School teachers may have an increased risk of cardiovascular disease (CVD), potentially affecting their work productivity. However, limited data exists on the impact of...
BACKGROUND
School teachers may have an increased risk of cardiovascular disease (CVD), potentially affecting their work productivity. However, limited data exists on the impact of CVD on teachers' productivity in Malaysia. Our objectives were to assess work productivity loss (absenteeism and presenteeism) as well as to determine the associated annual monetary loss among school teachers who experienced incident CVD in Peninsular Malaysia.
METHODS
We adopted a nested case-control design within a cohort of school teachers. Working teachers from six states of Peninsular Malaysia, and had experienced incident CVD before a right-censored date (31st December 2021) were defined as cases. Incident CVD was operationally defined as the development of non-fatal acute coronary syndrome (ACS), stroke, congestive cardiac failure, deep vein thrombosis or peripheral arterial disease before the censored date. Controls were working teachers who did not acquire an incident CVD before the similar right-censored date. All controls were randomly selected, with a ratio of one case to four controls, from among the working teachers in one of the states in Peninsular Malaysia. We used a shortened version of the Malay-validated World Health Organization-Health and Work Performance Questionnaire (WHO-HPQ) to estimate the workplace productivity effect among teachers with incident CVD (cases). The same questionnaire was distributed to teachers in a single state of Peninsular Malaysia who did not experience incident CVD (controls). Absenteeism, presenteeism and annual monetary loss were computed based on the scoring rules in the WHO-HPQ. Analysis of covariance was performed with covariate adjustment using propensity scores. The bootstrapping method was applied to obtain better estimates of marginal mean differences, along with standard errors (SE) and appropriate effect sizes.
RESULTS
We recruited 48 cases (baseline mean age = 42.4 years old, 54.2% females) and 192 randomly selected controls (baseline mean age = 36.2 years old, 99.0% females). The majority of the cases had ACS (73.9%). No significant difference was observed in absenteeism between cases and controls. The mean self-rated job performance score was lower for cases (7.63, SE = 0.21) compared to controls (8.60, SE = 0.10). Marginal mean scores of absolute presenteeism among cases (76.30) were lower ( < 0.05, eta squared = 0.075) than controls (85.97). The marginal mean annual cost of presenteeism was higher in cases (MYR 21,237.52) compared to controls (MYR 12,089.74) ( < 0.05, eta squared = 0.082).
CONCLUSION
Absolute presenteeism was lower among school teachers who experienced incident CVD and the annual cost of presenteeism was substantial. Implementing supportive work strategies in school settings is recommended to increase absolute presenteeism, which can lead to a reduction in the annual cost of presenteeism among teachers experiencing incident CVD.
Topics: Female; Humans; Adult; Male; Work Performance; Malaysia; School Teachers; Cardiovascular Diseases; Case-Control Studies
PubMed: 38361766
DOI: 10.7717/peerj.16906 -
JBJS Essential Surgical Techniques 2024The flexor pronator slide is an effective treatment option for ischemic contracture and contracture related to spastic cerebral palsy, but little is known about the use...
BACKGROUND
The flexor pronator slide is an effective treatment option for ischemic contracture and contracture related to spastic cerebral palsy, but little is known about the use of the flexor pronator slide in other non-ischemic contractures. I propose a flexor pronator slide to simultaneously correct wrist and finger flexor contractures and preserve the muscle resting length. To avoid overcorrection of the deformity, I propose the use of a wide-awake local anesthesia with no tourniquet (WALANT) procedure, in which the patient is able to continually assist the surgeon in assessing the contracture release and improvement in finger movement. Additionally, the WALANT flexor pronator slide releases the specific muscles responsible for wrist and finger contractures (i.e., the flexor digitorum profundus, flexor carpi ulnaris, flexor carpi radialis, flexor digitorum superficialis, and pronator teres), sparing the intact finger functions.
DESCRIPTION
The patient in the video received a WALANT injection of 1% lidocaine with 1:100,000 epinephrine and 8.4% sodium bicarbonate in the operating room, and surgery was started 30 minutes after the injection to obtain the maximum hemostatic effect. The injections were performed from proximal to distal along the volar-ulnar skin markings from the distal upper arm to the distal third of the forearm. The total volume utilized in this patient was <7 mg/kg (approximately 100 mL). A 25 or 27-gauge needle was infiltrated under the skin at the medial aspect of the elbow and in the distal and proximal forearm fascia. A total of 25 to 40 mL anesthetic was injected at each site, which serves to numb the ulnar nerve. over the volar-radial and volar side of the mid-forearm and distal forearm to numb the median nerve. For the WALANT procedure, an additional 8 mg of dexamethasone was added as an adjuvant to prolong the analgesia and the duration of the nerve block. The skin incision was made over the ulnar border of the forearm, extending proximally just posterior to the medial epicondyle up to the distal third of the upper arm. The origin of the flexor carpi ulnaris was elevated first, then the flexor digitorum profundus and flexor digitorum superficialis were mobilized from the ulna and the interosseous membrane. The release continued in an ulnar-to-radial direction. The patient was awake throughout the procedure, so that the improvement in the contracture could be better assessed. Further dissection around the ulnar nerve was done to release the arcade of Struthers, the Osborne ligament, and the triceps fascia in order to prevent ulnar nerve kinking during anterior transposition. The medial epicondyle was identified, and the flexor pronator wad was released meticulously without joint capsule perforation and medial collateral ligament injury. The muscles were finally examined for contracture in full wrist and finger extension, and further release was performed if remaining contracture was observed. All released muscles were tension-free, suspended on the trunks and branches of the median nerve, ulnar nerve, and radial and ulnar arteries. The ulnar nerve was transposed anteriorly to the medial epicondyle. The subcutaneous tissues were sutured with an absorbable suture, and the skin was closed with the same suture in a subcuticular fashion with a drain.
ALTERNATIVES
Fractional or Z-lengthening of the flexor tendons is the alternative for finger and wrist flexion contractures.
RATIONALE
This patient had previously undergone multiple flexor tendon surgeries in the hand and forearm. The patient developed tight ring, middle, and little finger contractures that could not be passively extended with the wrist in neutral or dorsiflexion. This patient could not extend the proximal or distal interphalangeal joints of the middle, ring, and little finger in wrist extension. Conversely, wrist flexion extended all fingers. When the surgeon tried to extend the fingers with the wrist in extension, excessive force was required and a jog in the movement was appreciated in all small joints. This denoted contractures of the long flexors and flexor tendons of the forearm. Fractional or Z-lengthening may release the flexion contracture in such cases, but leads to loss of active flexion, disrupts the muscle resting length, and causes loss of flexion strength. Because our patient had very tight finger contractures, they were deemed not amenable to fractional or Z-lengthening. Therefore, we preferred the use of a flexor pronator slide to simultaneously correct wrist and finger flexor contractures while preserving the muscle resting length. To avoid overcorrection of the deformity, we preferred to perform a WALANT procedure, during which the patient could continually assist the surgeon in assessing the contracture release and improvement in finger movement. This patient returned to her computer job after the surgery.
EXPECTED OUTCOMES
The flexor pronator slide is an effective treatment option for ischemic contracture and contracture related to spastic cerebral palsy. In 1923, Page described the flexor pronator slide as a surgical option for the late management of compartment syndrome. He noted that the procedure allowed extensive correction of the flexion contracture with less impact on the muscle resting length compared with alternative procedures. Sharma and Swamy noted good hand function in 14 (74%) of 19 patients and an average grip strength of 75% of the contralateral hand following a flexor pronator slide for the treatment of moderate Volkmann contracture. A flexor pronator slide will simultaneously correct wrist and finger flexor contractures and preserve muscle resting length. To avoid overcorrection of the deformity, the flexor pronator slide can be performed as a WALANT procedure, during which the patient is able to continually assist the surgeon in assessing the contracture release and improvement in finger movement. Additionally, a WALANT flexor pronator slide releases the specific muscles responsible for wrist and finger contractures, sparing intact muscles. Good functional outcomes are expected, with a full return to work by 3 months postoperatively. Major complications, such as overcorrection of the deformity, anterior interosseous neurovascular bundle injury, ulnar nerve injury, and wound dehiscence, are unexpected for this procedure.
IMPORTANT TIPS
The treatment for a non-ischemic contracture of the wrist and fingers requires flexor pronator slide surgery to simultaneously correct the deformity without losing the resting muscle length and strength.Both fractional or Z-lengthening and flexor pronator slide surgery for such contractures yield straightforward contracture release. However, maximal preservation of the flexion power and muscle resting strength when releasing these contractures is possible only by shifting the flexor pronator muscles distally without affecting its resting length, which can be achieved by flexor pronator slide.A WALANT flexor pronator slide avoids overcorrection of the deformity because the patient is able to continually assist the surgeon in assessing the contracture release and improvement in finger movement.
ACRONYMS AND ABBREVIATIONS
FCU = flexor carpi ulnarisFCR = flexor carpi radialisWALANT = wide-awake local anesthesia with no tourniquetFPL = flexor pollicis longusDASH = Disabilities of the Arm, Shoulder and HandFDP = flexor digitorum profundusFDS = flexor digitorum superficialis.
PubMed: 38348363
DOI: 10.2106/JBJS.ST.23.00048 -
Annals of Medicine and Surgery (2012) Feb 2024Hyper-IgE syndrome (HIES), also known as Job syndrome, is a rare primary immunodeficiency disorder characterized by elevated serum IgE levels, recurrent infections, and...
INTRODUCTION AND IMPORTANCE
Hyper-IgE syndrome (HIES), also known as Job syndrome, is a rare primary immunodeficiency disorder characterized by elevated serum IgE levels, recurrent infections, and various clinical features. Early diagnosis, prompt management of infections, and supportive care are essential in improving outcomes for individuals with HIES. Genetic testing, including STAT3 gene sequencing, plays a crucial role in confirming the diagnosis. Further research is needed to enhance our understanding of HIES and develop targeted therapies to improve the quality of life for affected individuals.
CASE PRESENTATION
This case report presents the clinical features and management of a 37-year-old male with HIES, diagnosed at the age of 2 due to recurrent cold abscesses caused by Staphylococcal infections.
CLINICAL DISCUSSION
The patient exhibited typical symptoms of HIES, including recurrent eczema, frequent bacterial infections, mucocutaneous candidiasis, and various physical abnormalities. Diagnostic markers such as elevated IgE levels and eosinophilia supported the HIES diagnosis, which was further confirmed by the identification of a STAT3 gene mutation. Treatment primarily involved supportive measures and antibiotics for infections. The patient's blood test results and imaging findings revealed abnormalities such as low red blood cell count, elevated erythrocyte sedimentation rate, and pulmonary nodules.
CONCLUSION
This case report highlights the importance of early diagnosis, prompt management of infections, and the need for ongoing research to improve our understanding and treatment of HIES.
PubMed: 38333292
DOI: 10.1097/MS9.0000000000001670 -
Revista Brasileira de Medicina Do... 2023Characterized by high levels of emotional exhaustion and depersonalization and reduced professional accomplishment, burnout syndrome has been a major cause of psychic...
INTRODUCTION
Characterized by high levels of emotional exhaustion and depersonalization and reduced professional accomplishment, burnout syndrome has been a major cause of psychic illness in nursing workers, with a serious impact on the quality of services and on patient safety.
OBJECTIVES
To analyze the correlation between organizational climate, job satisfaction, and burnout in nursing workers.
METHODS
This is a cross-sectional study with a sample of 534 Brazilian nursing workers. We used the Organizational Climate Scale for Health Organizations, the Job Satisfaction Questionnaire (S20/23), and the Maslach Burnout Inventory. An analytical descriptive analysis of the data was performed using relative and absolute frequencies, mean, standard deviation, minimum, maximum, and correlation test between the variables.
RESULTS
Organizational climate and job satisfaction were evaluated as regular. With regard to burnout, moderate levels of emotional exhaustion, low levels of depersonalization, and high levels of professional accomplishment were observed. A strong positive correlation was found between job satisfaction and organizational climate; in addition to a moderate negative correlation between emotional exhaustion and both organizational climate and job satisfaction, and a moderate negative correlation between depersonalization and job satisfaction.
CONCLUSIONS
Organizational climate and job satisfaction had a negative correlation with burnout dimensions, representing possible protective factors.
PubMed: 38313086
DOI: 10.47626/1679-4435-2022-867 -
Journal of Occupational Health Jan 2024To evaluate whether trigger point acupuncture (TrPA) is beneficial for office workers who have reduced job performance (presenteeism) due to chronic neck and shoulder... (Randomized Controlled Trial)
Randomized Controlled Trial
Clinical effectiveness of trigger point acupuncture on chronic neck and shoulder pain (katakori) with work productivity loss in office workers: a randomized clinical trial.
OBJECTIVES
To evaluate whether trigger point acupuncture (TrPA) is beneficial for office workers who have reduced job performance (presenteeism) due to chronic neck and shoulder pain (katakori).
METHODS
A 4-week single-center randomized controlled trial was conducted on 20 eligible female office workers with chronic neck and shoulder pain of at least 3-month duration. The control group implemented only workplace-recommended presenteeism measures, whereas the intervention group received TrPA up to 4 times per month in addition to the presenteeism measures recommended by each workplace. The major outcome measure was the relative presenteeism score on the World Health Organization Health and Work Performance (WHO-HPQ). The secondary outcome measures were pain intensity (numerical rating scale), absolute presenteeism (WHO-HPQ), anxiety and depression (Hospital Anxiety and Depression Scale; HADS), catastrophic thoughts related to pain (Pain Catastrophizing Scale; PCS), and sleep (Athens Insomnia Scale; AIS).
RESULTS
All 9 cases in the intervention group and 11 cases in the control group were analyzed. TrPA up to 4 times per month reduced the intensity of neck and shoulder pain by 20% (P < .01, d = 1.65) and improved labor productivity (relative presenteeism value) by 0.25 (P < .01, d = 1.33) compared with the control group over 1 month. No significant differences were observed between the 2 groups in terms of absolute presenteeism score, HADS, PCS, or AIS.
CONCLUSIONS
These results suggest that regular intervention with TrPA may be effective in the relative presenteeism score before and after the intervention and the degree of neck and shoulder pain over 28 days compared with the control group.
Topics: Humans; Female; Work Performance; Shoulder Pain; Trigger Points; Treatment Outcome; Neck Pain; Acupuncture Therapy
PubMed: 38273431
DOI: 10.1093/joccuh/uiad016 -
AIMS Public Health 2023Burnout syndrome (BOS) is an affection mostly resulting from chronic job-related stress. Many studies have identified job-related and non-job-related factors associated...
OBJECTIVES
Burnout syndrome (BOS) is an affection mostly resulting from chronic job-related stress. Many studies have identified job-related and non-job-related factors associated with BOS. Our aim of this study was to assess the level of BOS in private and public hospital healthcare providers in Fako division, Cameroon and evaluate the impact of physical activity and sleep quality (SQ).
METHODS
The study was carried out in five randomly selected hospitals in Fako Division over a three-month period. Consenting doctors, nurses and laboratory technicians were recruited using consecutive sampling methods. Sociodemographic and professional characteristics were collected using a structured questionnaire. BOS was assessed using the Maslach Burnout Inventory Human Services Survey (MBI-HSS). Sleep quality (SQ) and physical activity (PA) were assessed using the Pittsburgh Sleep Quality Index (PSQI) and Global Physical Activity Questionnaire (GPAQ) respectively. Odd ratios and 95% confidence intervals were calculated and a statistical significance was set for -value < 0.05.
RESULTS
The mean age was 32 ± 6 years and 70.9% female. BOS prevalence was 66.3% with 71.4% in females and 53.9% in males ( = 0.002). Of the 232 participants with BOS, 65.7%, 52% and 53.7% had moderate to high emotional exhaustion, depersonalization and decreased personal accomplishment, respectively. Moderate to high PA as well as poor SQ were not significantly associated with BOS while longer sleep duration (>8 h) was associated with a greater odd of BOS.
CONCLUSIONS
The prevalence of BOS was high among healthcare professionals. While PA showed no protective effects, high sleep duration could increase its risk.
PubMed: 38187903
DOI: 10.3934/publichealth.2023054 -
Journal of Physiological Anthropology Jan 2024Predicting nurse turnover risk is crucial due to the global nursing shortage; however, existing predictors, such as fatigue and burnout, lack objectivity. Salivary...
BACKGROUND
Predicting nurse turnover risk is crucial due to the global nursing shortage; however, existing predictors, such as fatigue and burnout, lack objectivity. Salivary cortisol is a non-invasive marker of stress and fatigue, but its utility in predicting nurse turnover risk is unknown. We examined whether salivary cortisol profiles across three different day shifts in a month are predictors of the extent of nurses' reluctance to stay in their current jobs.
METHODS
This preliminary longitudinal study followed forty female nurses who engaged in shift work at a university hospital for 3 months. Data at enrollment were collected including demographics, working conditions, chronic fatigue (the Japanese version of the Occupational Fatigue/Exhaustion Recovery Scale), and burnout (Japanese Burnout scale). Salivary cortisol was measured before the three different day shifts (after awakening) during the first month, and the means of these measurements were used as the cortisol profile. The extent of reluctance to stay was assessed using the numerical rating scale at 3 months.
RESULTS
Among the forty female nurses (mean [SD] age, 28.3 [5.1]), all completed follow-up and were included in the analysis. The cortisol profile was associated with the extent of reluctance to stay (P = 0.017), and this association was significant despite adjustments for chronic fatigue and burnout (P = 0.005). A multiple regression model with chronic fatigue, burnout, and job tenure explained 41.5% of the variation in reluctance to stay. When the cortisol profile was added to this model, the association of the cortisol profile was significant (P = 0.006) with an R of 0.529 (ΔR = 0.114).
CONCLUSIONS
This preliminary study conducted in an actual clinical setting indicated the potential of the salivary cortisol profile across three different day shifts in a month to predict nurses' reluctance to stay in their current jobs. The combination of subjective indicators and the cortisol profile would be useful in predicting nurses' turnover risk.
Topics: Humans; Female; Adult; Hydrocortisone; Longitudinal Studies; Fatigue Syndrome, Chronic; Burnout, Professional; Nurses; Surveys and Questionnaires
PubMed: 38167248
DOI: 10.1186/s40101-023-00349-w -
PloS One 2023Healthcare is characterized by professional, organizational, and institutional boundaries. Digital health innovations can help overcome these boundaries by providing...
Healthcare is characterized by professional, organizational, and institutional boundaries. Digital health innovations can help overcome these boundaries by providing information access to all healthcare professionals. Such innovations emerge from inputs from different health professionals at different positions along the entire care process and have the potential to substantially change the way in which interprofessional tasks are performed among the involved professionals. Consequently, as less empowered professionals, physiotherapists may resist the adoption of digital health innovations in particular if the innovation is dominated by physicians, and thus the not-invented-here syndrome may become a major barrier. We aim to examine whether the origin of a digital health innovation affects German physiotherapists' adoption decision and whether the collaboration quality and physiotherapists' proactive job crafting behavior may help overcome adoption barriers. We applied a mixed-method sequential design with a qualitative study one in which we interviewed 20 physiotherapists to provide exploratory insights, and a quantitative study two in which we tested our proposed hypotheses with survey data including an experimental vignette from 165 physiotherapists. Physiotherapists adopt digital health innovations developed by their own professional group more likely than digital health innovations developed by physicians. Our results also confirm that physiotherapists' job crafting behavior and the quality of the collaboration with physicians weaken the resistance against physician-driven innovations. Our study underlines (1) the need to involve allied health professionals as physiotherapists in digital health innovation development, (2) the relevance of interprofessional collaboration in daily practice and, (3) an open mind set of allied health professionals to cope with innovation adoption barriers.
Topics: Humans; Digital Health; Attitude of Health Personnel; Physical Therapists; Qualitative Research; Allied Health Personnel
PubMed: 38150453
DOI: 10.1371/journal.pone.0293550 -
Risk Management and Healthcare Policy 2023Karoshi syndrome, also known as "death by overwork", has been a topic of study and concern in Japan since the 1980s. World Health Organization (WHO) and International...
Karoshi syndrome, also known as "death by overwork", has been a topic of study and concern in Japan since the 1980s. World Health Organization (WHO) and International Labour Organization (ILO) joint unveiled that in 2021, approximately 750.000 deaths due to Karoshi syndrome globally. The joint defined long working as having > 55 h work/week. Karoshi nowadays is no longer limited to Japan and has become a global issue. Karoshi is primarily attributed to factors such as long working hours, job-related stress, and poor work-life balance. This perspective was sought to provide a short overview of Karoshi syndrome, the underlying mechanisms and the state-of-art preventive measures.
PubMed: 38145211
DOI: 10.2147/RMHP.S444900