The effect of tocopherol on high-density lipoprotein cholesterol. A clinical observation.

A significant redistribution of cholesterol in lipoproteins following ingestion of large doses of D,L-alpha tocopherol (vitamin E) is documented. In persons with decreased high-density lipoprotein (HDL) cholesterol a complex response occurs, which includes cholesterol redistribution in favor of the HDL fraction, with decreases in very-low-density lipoprotein (VLDL) levels and total triglycerides. The response was studied in five persons with average cholestrol distributions and five persons with cholesterol distributions associated with high risk of coronary heart disease. The mean elevation of the HDL cholesterol concentration in the former group was 168% of the initial value, while the latter group experienced post-therapy levels 375% of initial levels.

Predictors of rate of return to work after surgery for carpal tunnel syndrome.

OBJECTIVE: To evaluate the impact of patient demographics, clinical features, and job-related factors on the time until return to work after carpal tunnel release surgery. METHODS: We employed a cross-sectional community-based study of 59 patients who had undergone carpal tunnel release surgery. Sociodemographic, clinical, and job-related characteristics and time to return to work were obtained by interview and from medical records. Exposure to ergonomic risk was derived from an independently validated job matrix. Time to return to work after surgery was analyzed by survival techniques. RESULTS: Median time to return to work was 5 weeks. After adjustment, the relative rate (RR) of return to work per week after surgery was most strongly decreased by the receipt of workers' compensation, RR 0.2 (95% confidence interval [CI] 0.1-0.5), and by the exposure to bending and twisting of the hand prior to surgery, RR 0.7 (95% CI 0.5-0.9) per hour. Female gender was another predictor of decreased return to work, RR 0.5 (95% CI 0.3-0.8). CONCLUSIONS: Patients receiving workers' compensation, those exposed to higher levels of bending and twisting of their hands and wrists, and women were slower to return to work after carpal tunnel release surgery.

Depression in painful chronic disorders: the role of pain and conflict about pain.

Chronic pain severity, the responses of the significant other to the patient's pain, and social network relationships were investigated for their contributions to depression among patients with myofascial pain disorders (N = 67) and arthritis (N = 83). Interview data were gathered using the Beck Depression Inventory, McGill Pain Inventory, Multidimensional Pain Inventory, and Interpersonal Relationships Inventory. Patients with myofascial pain disorders reported significantly more severe depression and pain, more conflict about their pain, and more network conflict than those with arthritis. They also reported less network social support. After controlling for the type of painful chronic disorder, multiple linear regression analyses indicated that more severe depression was significantly associated with more severe pain, conflict about pain, and less network social support. Conflict about pain may increase the risk of depression for patients with chronic painful disorders. Patients with myofascial pain disorders, however, may experience more conflict about their pain because of the absence of objective physical findings that corroborate the report of pain.

Differences in postoperative pain severity among four ethnic groups.

Subjects (N = 543) reporting on acute postoperative dental pain were classified into four major ancestral groups: Asian (N = 96), black American (N = 65), European (N = 296), and Latino (N = 88). Pain severity was measured using a 10-cm visual analogue scale following a standardized operative procedure. The subjects of European descent reported significantly less severe pain than those of black American or Latino descent. They also reported less pain than Asians, although this finding did not reach significance. Evaluation of covariates, including gender, age, education, generation in the United States, and difficulty of the surgical extraction, demonstrated that gender was significant, with men reporting less pain than women regardless of ancestry. Possible implications of these findings are discussed in terms of potential differences in physiology, in addition to social learning.

A survey of health promotion programs in U.S. and Canadian medical schools.

A health promotion and wellness survey questionnaire was sent to all 143 accredited medical schools in the United States, Canada, and Puerto Rico. Of the 120 responding schools, 29 (24.2%) offer health promotion programs and 91 (75.8%) do not; most programs began only recently (average 5.42 years). Nineteen schools plan to begin programs soon. Most emphasized in the programs is physical well-being and least emphasized is spiritual well-being. Over 50% of the schools offer these components: study skills (62.1%), support groups (62.1%), time management (58.6%), aerobics (55.2%), intramural sports (55.2%), and financial planning (51.7%). Most programs are administered by the Dean of Student Affairs, 48.3% have a budget, and 51.7% have an evaluation component. All schools with programs expressed an interest in developing a network to share information. Emphasizing health promotion and disease prevention throughout medical education is important, particularly as an approach to enhancing the doctor-patient relationship.

Chronic low back pain: early interventions.

Low back pain is a common and costly social problem. Many of the long term outcomes of chronic low back pain (CLBP), such as those related to occupational and social function or patient and family coping, are sensitive to nursing intervention. To identify potentially productive areas for nursing intervention research, studies from 1990 to 1998 were reviewed that investigated (a) potential early indicators that acute or subchronic low back pain would result in chronic pain and disability, (b) patient perspectives on adaptation to chronic pain, and (c) the value of interventions undertaken during the acute and subchronic phases of back pain to modify long-term outcomes. Sixteen quantitative studies were identified that prospectively investigated the natural history and outcomes of low back pain. Six qualitative studies that investigated the perspectives of patients with back pain were also identified. Ten randomized clinical trials were identified that investigated interventions undertaken during the acute or subchronic stages of back pain. Clinical interventions that included advice to re-engage in activity, support to develop personalized goals, reinforcement for healthy gains and appropriate functional activities, and physical conditioning exercises tended to be successful in returning patients to work or limiting their self-reported disability and pain. Interventions that promoted communication at the work-site or modified the patient's job were also successful in promoting a faster return to work. Nonetheless, this is a nascent area of research in need of improvements related to the selection of appropriate subjects and controls, the timing and duration of interventions, and the reliability with which interventions are implemented. Furthermore, patients with back pain are most likely to benefit when nursing theories about chronic pain are linked to clinical intervention research.

Musculoskeletal symptoms related to video display terminal use: an analysis of objective and subjective exposure estimates.

The occupational use of video display terminals (VDTs) has been associated with the increasing incidence of upper extremity musculoskeletal disorders, often called cumulative trauma disorders. To guide clinical and policy decisions about the prevention and treatment of these VDT related disorders, valid and economic measures of total daily VDT use and VDT related job tasks such as data entry or editing will be important. In this study of newspaper reporters and copy editors (n = 83), VDT use was measured with employee self reports and by sampling the work behaviors of a subsample of employees. Behavioral sampling estimated VDT use as a characteristic of the job as opposed to a characteristic of individual employee performance. Overall, the two techniques of measuring occupational VDT use compared favorably, with the exception that self reported hours of VDT use tended to exceed the hours of use estimated by behavioral observation for employees who were younger and those who reported greater job demands. The findings suggest that behavioral sampling is a valid technique for estimating VDT use as a job characteristic.

Video technology. Use in nursing research.

Video technology is becoming more popular as a research tool because it has unique features that capture accurately and comprehensively the nature of nursing phenomena. Video technology is used extensively in nursing as an educational tool or intervention, a means of monitoring quality assurance standards, and as tool to collect research data. Videotaping is useful because is provides continuous multi-media, multisensory information about the subject and its context. Credibility for video data is based on the question of to what extent do the data or results adequately represent true behavior. The three main issues in video research that impact the credibility of data are observer bias, participant reactivity to knowledge of being videotaped, and maintenance of consistent data quality. Not all threats to credibility can be overcome. The key is to acknowledge insurmountable problems, to consider their limitations in data analysis, and to evaluate and report their effects.

Ergonomic evaluation of winegrape trellis systems pruning operation.

The winegrape industry suffers from high incidence rates of work-related musculoskeletal disorders. Pruning of dormant vines is a significant task, requiring long periods of highly repetitive and physically demanding work. The purpose of this study is to quantitatively evaluate five commonly used winegrape trellis systems with regard to the risk of developing musculoskeletal injuries to the wrist and lower back while pruning. Eleven subjects participated in this study. Subjects performed a simulated pruning task as wrist and trunk postures were gathered using electrogoniometers. The results showed significant postural differences among the trellis systems. Compared to the other systems, the VSP was determined to be the optimal system in terms of decreasing relative MSD risk. These results will assist vineyards in the selection process of suitable trellis systems that will include the worker health aspect in conjunction with other trellis-related parameters such as grape quality and productivity.

VDT-related musculoskeletal symptoms: interactions between work posture and psychosocial work factors.

Video display terminal (VDT) operators (n = 150) in the editorial department of a large metropolitan newspaper participated in a study of day-to-day musculoskeletal symptoms. Work posture related to the VDT workstation and psychosocial work factors were also investigated for their contributions to the severity of upper body pain, numbness, and stiffness using a representative subsample (n = 70). Self-report measures included Karasek's Job Content Instrument and the author-designed Work Interpersonal Relationships Inventory. Independent observations of work posture were performed using techniques similar to those reported by Sauter et al. [1991]. Pain during the last week was reported by 59% (n = 88) of the respondents, and 28% (n = 42) were categorized by symptom criteria potentially to have musculoskeletal disorders. More hours per day of VDT use and less decision latitude on the job were significant risk factors for potential musculoskeletal CTDs. Head rotation and relative keyboard height were significantly related to more severe pain and stiffness in the shoulders, neck, and upper back. Lower levels of co-worker support were associated with more severe hand and arm numbness. For both the region of the shoulders, neck, and upper back and the hand and arm region, however, the contributions of relative keyboard and seat back heights to symptom severity were modified by psychological workload, decision latitude, and employee relationship with the supervisor. Alternative explanations for these findings are discussed.

Job strain among registered nurses and other hospital workers.

OBJECTIVE: The authors describe factors associated with job strain for various job titles in the acute care hospital using the Karasek Job Strain Model, discuss the reliability and validity of the Job Content Questionnaire, and discuss use of the model to enhance the work environment. BACKGROUND: The Karasek Job Strain Model has been used to describe many occupations in the United States and other countries. Some research indicates that occupations that arouse stress hormones are those in which employees have little job control or must complete psychologically demanding tasks, such as those under time pressure, and these positions can be describe as high-strain jobs. METHOD: This descriptive correlational study was conducted at five tertiary care hospitals on the West Coast. A purposive volunteer sample of staff members working at least 20 hours per week in the adult medical-surgical and specialty nursing units was recruited. RESULTS: Mean scores for each of the nursing units and the overall mean scores for the staff in the initial analysis fell into the Active Work quadrant of the Karasek Job Strain Model. When nursing job titles were analyzed, registered nurses had significantly higher Decision Latitude scores than did nurse assistants (P < 0.001) and clerical staff (P < 0.001), but there were no significant differences for Psychological Demands. CONCLUSIONS: Working with nurse assistants to appropriately increase decision latitude related to their work has the potential to enhance the work environment by reducing job strain and improving staff health and morale.

Graduating medical students' ratings of stresses, pleasures, and coping strategies.

The authors' objective in the study reported here was to gather data on the stress and coping of medical students in order to design a health promotion and wellness program. A retrospective questionnaire was completed by 71 of 157 graduating seniors. Examinations, classwork, and financial responsibilities were considered the three most stressful aspects of medical education. The most uplifting items (that is, pleasant, happy, or satisfying experiences) were recreation and social interaction, although good examination performance was rated second highest. Planful problem-solving (that is, deliberate problem-focused efforts to alter a situation) was the most frequently used form of coping, although four of the eight forms of coping assessed were used at least moderately often and all eight were used to some extent.

The process of coping with a gross anatomy exam during the first year of medical school.

A total of 42 freshman medical students were evaluated before a major exam, after the exam and before grades were announced and after grades were announced. They completed measures relating to mood, emotions, coping, social support and stakes. Significant time and academic performance differences were found in many domains.

Self-reported carpal tunnel syndrome: predictors of work disability from the National Health Interview Survey Occupational Health Supplement.

The objective of this study was to identify risk factors for work disability among persons with carpal tunnel syndrome (CTS). The study was designed to analyze data from the Occupational Health Supplement of the National Health Interview Survey, a nationwide, population-based survey. Subjects included 544 survey respondents with self-report of CTS and 32,688 survey respondents without CTS, all aged 18-64 years, and with a history of labor force participation. Measurements were as follows: Dependent variables were work disability, defined either as cessation of employment without attribution of cause or, alternatively, as cessation of employment or job change specifically attributed to CTS by the survey respondent. Independent variables were ergonomic risk of work disability, defined by minutes of workplace repetitive hand and wrist bending for the most recent job held. This measure was derived from responses categorized by an occupation and industry matrix independent of CTS status. Socio-demographic and health status risk factors for work disability were based on the respondent report. The main results were as follows: Among 544 persons with CTS, 58 (11%, CI 8-13%) reported work disability specifically attributed to CTS, representing an estimated national prevalence of 240,578 persons with this limitation. Workplace ergonomic risk, measured as repetitive hand or wrist bending in the occupation and industry of last employment, was a significant factor predictive of CTS-attributed work disability (per 120 min of daily exposure, OR 1.7, CI 1.1-2.6), even after taking into account socio-demographic factors and health status. The conclusions were that work disability among persons with CTS is common. For those with CTS, working conditions characterized by repetitive bending of the hand or wrist may increase the risk of work disability associated with this condition.

Injury severity associated with nonfatal construction falls.

This study evaluated injury severity in a group of construction workers who sustained nonfatal falls at work. The sample consisted of 255 adults who were identified from Doctor's First Reports (DFRs) submitted to the California Department of Industrial Relations. For those that fell from heights (n = 195), the mean height of fall was 9.2 feet (SD = 7.1). The mean number of lost work days was 44.3 days (SD = 58.6) and the median was 10 days. Two measures of injury severity were used--the Injury Severity Score and the disability section of the Health Assessment Questionnaire (HAQ). Seventeen participants (7%; 95% CI, 4-10%) were deemed permanently disabled. A simultaneous multiple regression model, using five independent variables, explained approximately 21% of the variance in HAQ scores. Nonunion status and safety climate scores indicating increased risk were positively correlated with higher functional limitation as measured by HAQ scores, as were greater heights and impact on concrete surface. Higher scores on both injury severity measures were significantly and moderately associated with a greater number of days lost from work. These findings suggest that injury severity and permanent disability associated with falls in construction are notable, and identify key target areas for intervention and prevention.

The effect of Orem's self-care model on nursing care in a nursing home setting.

The need of the functionally disabled for nursing care is a primary rationale for institutionalization in long-term care settings. However, maintenance of the self-care abilities that nursing home residents retain is an important component of their quality of life. Nurses are in an important position to encourage and sustain residents' abilities to participate in their care. Nevertheless, without specifying the role of the resident in care, nursing interventions may inadvertently reinforce dependency and apathy at the expense of autonomy, control and well-being. Data from nursing home care records and interviews suggest that nursing staff using Orem's Self-Care Deficit Nursing Theory differ in their nursing assessments and goals of care from staff on a control unit. Further study is recommended of the influence of the model on staff perspectives of care and on interventions which support nursing home residents' self-care ability and well-being.

A retrospective study of attitude change during medical education.

A retrospective attitude questionnaire was administered to 70 of 157 graduating seniors at the end of the medical school year. Students perceived that they became more cynical during medical education. In addition, they perceived that they were more concerned with making money, more concerned for patients, and more helpful. These findings relate to the developmental stressors of medical education as they affect the individual student. Burn-out and impairment are possible consequences; a preventive approach is advocated.