Sarcopenia and excess visceral fat accumulation negatively affect early urinary function after I-125 low-dose-rate brachytherapy for localized prostate cancer.

OBJECTIVES: To evaluate the effects of sarcopenia and excess visceral fat accumulation on early urinary function after I-125 low-dose-rate brachytherapy for prostate cancer. METHODS: We retrospectively reviewed consecutive patients who underwent brachytherapy for prostate cancer. Pre-treatment computed tomography was used to measure skeletal muscle index at the L3 level to assess sarcopenia and visceral fat area at the umbilical level. The International Prostate Symptom Score and the University of California Los Angeles Prostate Cancer Index were used to assess quality of life during the 24 months after brachytherapy. Logistic regression analysis was used to examine whether sarcopenia and excess visceral fat accumulation had clinically significant effects on post-treatment quality of life. RESULTS: Among 246 patients, 92 (37.4%) were stratified into the sarcopenia group and 141 (57.3%) into the excess visceral fat accumulation group. The sarcopenia group had significantly lower University of California Los Angeles Prostate Cancer Index urinary function than the non-sarcopenia group 24 months post-brachytherapy. The excess visceral fat accumulation group had significantly poorer International Prostate Symptom Score total, storage, and voiding scores than the non-excess accumulation group 12 months post-brachytherapy. In the multivariate analysis, sarcopenia had a clinically significant adverse effect on the University of California Los Angeles Prostate Cancer Index urinary function at 12 months. Excess visceral fat accumulation had a clinically significant adverse effect on the International Prostate Symptom Score voiding and storage scores at 12 months. CONCLUSIONS: Sarcopenia and excess visceral fat accumulation negatively affect urinary function early after I-125 low-dose-rate brachytherapy for prostate cancer.

Clinical outcomes of iodine-125 low-dose-rate brachytherapy for localized prostate cancer: a single-institution review in Japan.

Purpose: To evaluate the oncological outcomes and genitourinary and gastrointestinal adverse events in acute and late-phases of iodine-125 low-dose-rate brachytherapy for localized prostate cancer. Material and methods: We retrospectively evaluated 334 patients treated for localized prostate cancer with low-dose-rate brachytherapy. Bio-chemical relapse-free survival, cause-specific survival, and overall survival were evaluated using Kaplan-Meier method and log-rank test. Incidence of adverse events was calculated using National Cancer Institute common terminology criteria for adverse events, version 5. Logistic regression was used to identify independent predictors of acute and late-phase genitourinary and gastrointestinal adverse events. Results: National Comprehensive Cancer Network's low-, intermediate-, and high-risk groups included 133 (39.8%), 163 (48.8%), and 38 (11.3%) patients, respectively. The 5-year cause-specific survival rate was 100%. The 5-year bio-chemical relapse-free survival rates for the low-, intermediate-, and high-risk groups were 98.3%, 95.8%, and 100%, respectively. One patient had a ≥ grade 3 acute adverse event. The 5-year cumulative ≥ grade 1, ≥ grade 2, and ≥ grade 3 genitourinary adverse event rates were 27.9%, 14.4%, and 0.5%, respectively. The 5-year cumulative ≥ grade 1, ≥ grade 2, and ≥ grade 3 gastrointestinal adverse event rates were 3.1%, 1.5%, and 0.5%, respectively. A high pre-treatment international prostate symptom score and non-use of α1-blockers were associated with an increased risk of acute genitourinary adverse events. Conclusions: Low-dose-rate brachytherapy had good oncological outcomes, with acceptable adverse event rates. Pre-treatment urinary function and use of α1-blockers may be useful in predicting and preventing acute genitourinary adverse events.

Severe immersion pulmonary edema in a novice elderly scuba diver after heavy alcohol intake.

BACKGROUND: There are no reports of immersion pulmonary edema induced by excessive alcohol intake. We describe the case of a novice scuba diver who developed apnea due to immersion pulmonary edema during scuba diving after heavy alcohol intake. CASE PRESENTATION: A 71-year-old hypertensive man, without regular antihypertensive therapy, performed diving after excessive alcohol intake (total amount, approximately 253 g) until the night before. When swimming at a depth of 12 m, the patient experienced chest discomfort and ascended immediately but became unconscious. Respiratory arrest was confirmed, and he spat pink foamy sputum. On hospital admission, hypoxemia was confirmed, and chest radiography revealed butterfly-shaped shadows. Therefore, mechanical ventilation was initiated. The next day, his blood oxygenation level improved, and the radiographic shadows disappeared. He was discharged on day 7 of hospitalization without sequelae. CONCLUSION: A scuba diver with untreated hypertension might develop immersion pulmonary edema during diving after heavy alcohol intake.

[New Therapeutic Strategies and Future Issues in Hyperbaric Medicine].

Hyperbaric medicine includes two different medical fields: hyperbaric oxygenation (HBO) as emergency and intensive care, and diving medicine. Recent topics in hyperbaric therapy include radiation oncology and regenerative medicine. Of special interest are clinical studies of radiotherapy after HBO that were conducted at some institutes to evaluate its therapeutic effects for cancer patients. A few studies have shown that HBO improves memory disturbance following traumatic brain injury and hypoxic and ischemic events. There is a great possibility that HBO enhances the therapeutic effects of radiotherapy and potentiates regenerative medicine. Randomized controlled trials, however, have indicated the re-examination of its viable treatment effects in some conditions, including decompression illness, carbon monoxide poisoning, and serious soft tissue infection. As recent trends in the treatment of decompression illness have changed on the basis of clinical series, the laws related to diving and caisson work should be amended in the future.

Longitudinal Changes in Health-related Quality of Life After 125I Low-dose-rate Brachytherapy for Localized Prostate Cancer.

BACKGROUND/AIM: The factors associated with longitudinal changes in health-related quality of life (HRQOL) are unclear. In this study we aimed to evaluate the longitudinal changes and predictors of HRQOL after 125I low-dose-rate brachytherapy (LDB) for localised prostate cancer (PCA). PATIENTS AND METHODS: We evaluated 180 patients with localised PCA treated with LDB. The HRQOL was evaluated at 3 weeks before LDB and at 1, 3, 6, 12, 18, 24, 36, and 48 months after LDB using the International Prostate Symptom Score, Medical Outcome Study 8-Items Short Form Health Survey (SF-8), and University of California Los Angeles Prostate Cancer Index (UCLA-PCI). RESULTS: All HRQOL scores, except for UCLA-PCI sexual function and SF-8 mental component summary (MCS), were improved to baseline after an early transient deterioration. In contrast, the sexual function did not return to baseline after early deterioration. Meanwhile, the MCS scores showed no significant decline after implantation and trended upward. The prostate V100 and baseline UCLA-PCI sexual function scores predicted a clinically significant decrease in sexual function in the late post-implantation period. CONCLUSION: Most aspects of the HRQOL of PCA patients who underwent LDB improved to baseline. The results that V100 and baseline sexual function were predictors of late post-LDB may provide more accurate information for patients with preserved sexual function before treatment and for their partners.

[Relationship between pregnancy factors and low birth weight infants, miscarriages, and stillbirths: A follow-up survey on birth conditions of pregnant women who received the maternal and child health handbook from public health nurses and midwives].

Objectives　The final evaluation of the Japanese government's Healthy Parents and Children 21 project in 2014 noted an increase in low birth weight infants as an aspect that worsened. In order to reduce the number of low birth weight infants, miscarriages, and stillbirths in Kurume City, we conducted a survey aimed at researching new measures, including the search for new risk factors of birth complications.Methods　The participants of this study were 2,986 pregnant women who submitted a pregnancy notification form in 2014. We excluded women who moved away from Kurume city or for whom birth weight records could not be obtained. Information from the pregnancy notification form was linked to birth weight records to examine the relationships between low birth weight infants, miscarriages, stillbirths, and pregnancy attributes. Variables that were shown to be related in an initial univariate analysis were analyzed further in a multiple logistic regression analysis with low birth weight, miscarriage, or stillbirth as the response variables.Results　A multiple logistic regression analysis showed that being 35 years or older (odds ratio [OR]: 1.41), height less than 158 cm (OR: 1.45), non-pregnant body mass index (BMI) less than 18.5 (OR: 1.48), and detection of physical abnormalities by a physician during the pregnancy (OR: 2.20) were independent maternal factors that were significantly associated with low birth weight. Being aged 35 years or older (OR: 2.05) and smoking (OR: 3.42) were independent factors that were significantly associated with miscarriage and stillbirth. In addition, the cessation of alcohol use (OR: 0.51) significantly reduced this risk.Conclusion　Because some biological factors such as "age" and "non-pregnant BMI" are invariable, we encourage pregnant women to get checkups to detect abnormalities early or to attend birthing classes that offer mental support, especially for pregnant women over 35 years. We want to tell young generations that pregnant women over 35 are at an increased risk of having low birth weight infants, miscarriages, and stillbirths, and those pregnant women with a lower BMI have an increased risk of low birth weight infants. "Maintenance of appropriate body weight," "smoking," "alcohol," socioeconomic issues such as "lack of systems for seeking advice and support staff," and "financial concerns" can be improved with health education from public health nurses and multidisciplinary support interventions. At the Children Care Support Center in Kurume city, professionals work together to provide continuous support to families during pregnancy, childbirth, and parenting. As a result, we may be able to contribute to reducing the number of low birth weight infants, miscarriages, and stillbirths.

The relationship of sleep complaints risk factors with sleep phase, quality, and quantity in Japanese workers.

Numerous studies have determined that lifestyle factors (smoking, drinking, snacking, etc.) and the bedroom environment can influence sleep. We developed a new sleep scale-the 3-Dimensional Sleep Scale (3DSS)-which measures three elements of sleep: phase, quality, and quantity. The purpose of this study is to determine which risk factors of sleep complaints are associated with these sleep elements. Data were obtained from 366 Japanese day workers (302 men and 64 women). Sleep condition was assessed with the 3DSS, and we also assessed various habits within 2 h of going to bed, including smoking, drinking, snacking, caffeine intake, mobile phone use, and working. We also asked about bedroom environmental conditions (noise, lighting, and temperature and humidity). Multivariate logistic regression analysis using the backward selection method (likelihood ratio) was used, with 3DSS scores as the outcome (i.e., over or under the cutoff). The results showed that smoking was associated with significantly greater odds ratio [2.71 (1.65-4.44)] of disordered sleep phase, while lighting as well as temperature and humidity led to greater odds [3.67 (1.55-8.68), 1.93 (1.20-3.11)] of poor sleep quality. Finally, only noise was significantly related to greater odds [1.98 (1.13-3.46)] of low sleep quantity. These findings indicated the various risk factors of sleep complaints could be associated with different sleep elements. This might help in the effective treatment of sleep complaints.

Comparison of subjective symptoms associated with exposure to low levels of formaldehyde between students enrolled and not enrolled in a gross anatomy course.

OBJECTIVES: This study aimed to evaluate students' subjective symptoms associated with exposure to low levels of formaldehyde (FA) during a gross anatomy course and to survey how the risk of subjective symptoms was affected by exposure to FA. METHODS: We conducted three questionnaire surveys of 125 students enrolled in an anatomy course (FA exposure group) and 124 students not enrolled in the course (FA nonexposure group) before, during, and 6 months after the course. The questionnaire included questions inquiring about subjective symptoms, sex, age, and allergies. We analyzed differences in the prevalence of subjective symptoms in distinct survey periods. Furthermore, we analyzed the relationship between the subjective symptoms and exposure to FA after adjusting for allergy, sex, and age using multiple logistic regression analysis. RESULTS: The prevalence of some of the ocular, nasal, and nonspecific symptoms in the FA exposure group was low before the course, increased during the course and decreased 6 months after the course. A significant positive relationship was observed between exposure to FA and some symptoms after adjusting for allergy, sex, and age. CONCLUSIONS: We identified some concrete symptoms associated with exposure to FA. We suggest that the exposure to low levels of FA influences students' subjective symptoms.

Relationship between sexual function and prostate-specific antigen bounce after iodine-125 permanent implant brachytherapy for localized prostate cancer.

OBJECTIVE: To analyze clinical and dosimetric factors involved in prostate-specific antigen bounce in patients who underwent permanent implant brachytherapy for localized prostate cancer, and to study the relationships among prostate-specific antigen bounce, age and sexual function. METHODS: Between March 2007 and April 2012, 116 patients with localized prostate cancer underwent permanent implant, iodine-125 brachytherapy. Patients receiving external-beam radiotherapy or who used phosphodiesterase-5 inhibitor pre- or post-treatment were excluded. Prostate-specific antigen bounce was defined as an increase of ≥0.2 ng/mL and ≥0.4 ng/mL above an initial prostate-specific antigen nadir followed by a subsequent decline to or below the initial nadir without treatment. Clinical and dosimetric factors involved in prostate-specific antigen bounce were analyzed using multivariate logistic regression analysis with the forced entry method. RESULTS: The median age was 66 years (range 51-80 years), and prostate-specific antigen bounce on a prostate-specific antigen rise of ≥0.2 ng/mL occurred in 47 of the 116 participants (40.5%). The median period before the prostate-specific antigen bounce was 17.5 months (range 8-36 months). Patients with prostate-specific antigen bounce were younger and had higher sexual function before treatment (P = 0.003) than those who not show prostate-specific antigen bounce. Regression analysis results showed that young age and a high level of pretreatment sexual function were significant predictive factors for prostate-specific antigen bounce (P = 0.028 and P = 0.048). CONCLUSION: Sexual function seems to be associated with a prostate-specific antigen bounce in patients undergoing permanent implant brachytherapy for localized prostate cancer, and it can be preserved after treatment if it is well present before treatment. Highly maintained sexual function after treatment might influence prostate-specific antigen bounce.

Changes in subjective symptoms and allergy state among medical students exposed to low-level formaldehyde 6 months after completion of a gross anatomy dissection course.

OBJECTIVES: Our purpose was to clarify whether subjective symptoms of low-level formaldehyde (FA) exposure in medical students were transient or persistent and to investigate whether the allergy state changed as a result of exposure. METHODS: We surveyed the prevalence of medical students' subjective symptoms and their allergy state before, during, and 6 months after completion of a gross anatomy dissection course by using two self-administrative questionnaires. Students completed the first survey at the end of the anatomy course to assess symptoms before and during the course. The second survey was completed 6 months after course completion. RESULTS: The prevalence of most subjective symptoms was lower 6 months after the course than during the course. The major symptoms experienced during the course were eye fatigue, runny nose, and dry eyes. The most common symptom 6 months after the course was eye fatigue. Four students continued to experience symptoms even after course completion. Three students developed symptoms only after course completion. Forty-eight students had allergies before the course began and the severity of the allergies did not change after the course. Additionally, the prevalence of most subjective symptoms 6 months after the course was lower than before the course. The patterns of subjective symptoms in the three periods differed between male and female students; the prevalence of most subjective symptoms tended to be higher in females. CONCLUSIONS: Subjective symptoms resulting from FA exposure during a gross anatomy course were transient and did not affect students' allergy states.

Quantitative evaluation of light scattering intensities of the crystalline lens for radiation related minimal change in interventional radiologists: a cross-sectional pilot study.

To evaluate low-dose X-ray radiation effects on the eye by measuring the amount of light scattering in specific regions of the lens, we compared exposed subjects (interventional radiologists) with unexposed subjects (employees of medical service companies), as a pilot study. According to numerous exclusionary rules, subjects with confounding variables contributing to cataract formation were excluded. Left eye examinations were performed on 68 exposed subjects and 171 unexposed subjects. The eye examinations consisted of an initial screening examination, followed by Scheimpflug imaging of the lens using an anterior eye segment analysis system. The subjects were assessed for the quantity of light scattering intensities found in each of the six layers of the lens. Multiple stepwise regression analyses were performed with the stepwise regression for six variables: age, radiation exposure, smoking, drinking, wearing glasses and workplace. In addition, an age-matched comparison between exposed and unexposed subjects was performed. Minimal increased light scattering intensity in the posterior subcapsular region showed statistical significance. Our results indicate that occupational radiation exposure in interventional radiologists may affect the posterior subcapsular region of the lens. Since by its very nature this retrospective study had many limitations, further well-designed studies concerning minimal radiation-related lens changes should be carried out in a low-dose exposure group.

[Effect of large-scale repair work on indoor formaldehyde levels upon and subjective symptoms in, medical students during gross anatomy dissection course].

OBJECTIVES: To examine the effect of large-scale repair work on indoor formaldehyde (FA) levels and subjective symptoms in medical students during a gross anatomy dissection course. METHODS: We measured the indoor FA levels, room air temperature, and room humidity during a gross anatomy dissection course. In addition, the prevalence of subjective symptoms, keeping allergy state, and wearing personal protective equipment were surveyed in two groups of students using a self-administered questionnaire. RESULTS: The mean indoor FA levels before and after repair work were 1.22 ppm and 0.14 ppm, respectively. The mean indoor FA level significantly decreased after repair work. The prevalences of most subjective symptoms before the anatomy practice were similar before and after the repair work. However, the prevalences of most subjective symptoms during the anatomy practice were lower after the repair work. CONCLUSIONS: The mean indoor FA levels and prevalences of subjective symptoms decreased after the repair work. We have to continuously monitor indoor FA levels, carry out private countermeasures to minimize exposure to FA, and maintain equipment for ventilation to be able to conduct practice in a comfortable environment.

[Relatedness of occupational exposure to whole-body vibration and health, principally back symptoms].

OBJECTIVES: DISCUSSION is continuing about whether or not to update the Occupational Exposure Limit for Whole Body Vibration exposure (OELWBV) which was established in 1975 as a part of the Recommendation of Occupational Exposure Limits (OEL), issued by the Japan Society for Occupational Health. The objectives of this study were to clarify the necessity of the update and the adverse health effects of whole-body vibration by reviewing the literature and to help to compile a for detailed revisions. SUBJECTS AND METHODS: Mainly referring to our preceding review, the current OELWBV exposure was examined. The relatedness of adverse health effects, principally back symptoms and occupational exposure to whole-body vibration (WBV) was examined by reviewing review papers, the original English papers referred to in those papers, and original English and Japanese references from 2002 to 2010 retrieved through a MEDLINE search. RESULTS: The results show the necessity of updating the present OELWBV as soon as possible. The overwhelming majority of the literature consists of epidemiological studies showing the relatedness of WBV to back symptoms. Thirty epidemiological studies out of 28 literatures clearly show the presence of a relationship between WBV and back symptoms. Various indices of exposure to WBV and back symptoms show the dose response relationships. Among these, a few studies used A(sum)(8) (equivalent 8-hour r.m.s. acceleration value for the combined frequency-weighted vibration of three diagonal, that is x, y and z, axes) as the exposure index. All of these studies reported some dose-response relationship between WBV exposure and back symptoms. DISCUSSION: Despite the clear presence or absence of a relationship between WBV and back symptoms, 0.5 m/s(2) seems to be the unconfirmed threshold of risk. Focusing on data of A(sum)(8), we suggest that the risk increases over the magnitude of 0.30 m/s(2). To clarify this, further epidemiological studies and others should focus on A(sum)(8) around 0.30 m/s(2). CONCLUSIONS: The present OEL of WBV should be examined from the viewpoint of the risks of back symptoms referring to the epidemiological studies that show the larger risks of back symptoms in comparison with unexposed referent workers. We conclud that when updating the present OELWBV, A(sum)(8) should be taken into account for back symptoms, referring to the findings of epidemiological studies.

A health promotion program at a Japanese newspaper undergoing restructuring.

Occupational health activities based on a health promotion philosophy and focused on primary and secondary prevention were introduced at a Japanese newspaper company where restructuring had occurred. Japanese metabolic syndrome diagnostic standards were used to determine changes in certain lifestyle disease risk factors over 10 years. The amount of change from 1998 to 2007 was determined, and two groups (i.e., 1998 and 2007) were compared using paired t-tests. Results suggested that the occupational health activities focused on primary prevention had been effective. The authors concluded that, in situations where industrial change and corporate restructuring are occurring, occupational health activities based on a health promotion philosophy and focused on primary and secondary prevention are more effective than diagnostic activities and other types of health management focused on tertiary prevention.

[Change of citizen's expectations for health activity in transition to a "Core City": focus on newly established public health centers].

PURPOSE: This article aims to predict the future course of city administration and public health centers through clarifying the actual state and local residents' expectations of new public health centers on becoming a "Core City". METHOD: Online questionnaire surveys targeting Kurume City residents were conducted in March 2008 (before becoming a Core City) and in October 2008, six months after becoming a Core City. Questions involved awareness of the Core City concept and the expectations for administration of the Core City and its new public health centers. RESULT: The recognition rate for the Core City concept was 62.6% in the first questionnaire survey and 78.9% in the second survey, demonstrating a significant increase (P < 0.001). The expectations for the Core City centered on "Vitalization of the city" in both surveys. However, in the second survey results, "Nothing in particular" accounted for 81.2% of the responses for what the residents felt as a change after becoming a Core City. On the other hand, "Vitalization of the city" recorded 5.5% for the same question, showing a low rate. "Health promotion, Cancer check-ups, and Vaccination" were the most commonly chosen responses regarding expectations of the new public health centers in both surveys, accounting for approximately 30%. Nonetheless, the response to a question asking about actual utilization of the public health centers revealed a high rate of 83.4% for "Nothing in particular" in the second survey result. The recognition rate for the "Health Promotional Members" system implemented by the Kurume City public health centers from 2007 was a low 6.5%. Furthermore, the responses to the "District-Assigned Public Health Service" system to be introduced from 2009 were: In favor 52.6%, Opposed 3.0%, and Neither 44.3%. CONCLUSION: Although residents' expectations of public health centers are high, the surveys revealed that the health promotional activities provided by the public health centers were not fully utilized. In the future, the recognition rate of the "District-Assigned Public Health Service" starting in 2009 should be improved as quickly as possible to enhance the support system to accommodate individual health needs.

Bilateral neurovascular bundles sparing prostatectomy preserves sexual function in patients with localized prostate cancer.

The influence of the presence or absence of the neurovascular bundles on patient QOL were examined using the UCLA Prostate Cancer Index (UCLA-PCI) in patients who underwent radical retropubic prostatectomy. The study was performed in 105 patients who were histopathologically diagnosed with prostate cancer and underwent radical retropubic prostatectomy (During prostatectomy, the bilateral neurovascular bundles were preserved in 45 patients (42.8%), unilateral neurovascular bundle preservation was achieved in 24 (22.9%), and no neurovascular bundles were preserved in 36 (34.2%)). The QOL was evaluated before and after surgery using the Japanese edition of the UCLA-PCI, which examines 6 items. Our findings suggested that 'urinary function, 'urinary bother', 'bowel function', and 'bowel bother' deteriorated early after surgery, and recovered to the preoperative levels in the late phase after surgery, but no significant difference was noted in the time-course among the three groups. In contrast, 'sexual function' was significantly improved in the late postoperative phase only in the bilateral nerve-spared group, but not in the unilateral nerve-spared and non-nerve-spared groups. Patients complaining of 'Sexual bother' were more prevalent in the unilateral nerve-spared group in the late postoperative phase, but the difference was not significant. On multiple regression analysis of factors associated with sexual function in the late postoperative phase, only bilateral nerve preservation of was significantly associated with sexual function in the late postoperative phase (p<0.0001). In order to maintain sexual function following radical retropubic prostatectomy, the bilateral neurovascular bundles should be preserved, as far as practicable.

A detailed analysis of musculoskeletal disorder risk factors among Japanese nurses.

INTRODUCTION: Although Musculoskeletal Disorders (MSD) represent a common occupational problem, few epidemiological studies have investigated MSD risk factors among Asian nurses, particularly those in Japan. METHOD: We administered a modified Japanese-language version of the Standardized Nordic Questionnaire to 1,162 nurses from a large teaching hospital. MSD categories focused on the neck, shoulder, upper back, and lower back regions. RESULTS: A total of 844 completed questionnaires were analyzed (response rate: 72.6%). The 12-month period-prevalence of MSD at any body site was 85.5%. MSD was most commonly reported at the shoulder (71.9%), followed by the lower back (71.3%), neck (54.7%), and upper back (33.9%). Alcohol consumption, tobacco smoking, and having children were shown to be significant risk factors, with adjusted Odds Ratios of 1.87 (95%CI: 1.17-2.96), 2.45 (95%CI: 1.43-4.35), and 2.53 (95%CI: 1.32-4.91), respectively. Workplace risk factors included manually handling patients (OR: 2.07 to 11.97) and undertaking physically laborious work (OR: 2.09 to 2.76). Nurses reporting pre-menstrual tension were 1.66 and 1.94 times more likely to suffer from lower back and upper back MSD, respectively. High mental pressure was also identified as a significant risk factor for MSD of the neck (OR: 1.53) and shoulder (OR: 2.07). IMPACT ON INDUSTRY: The complex nature of MSD risk factors identified during this study suggests that remediation strategies which focus only on manual handling tasks would probably be suboptimal in reducing MSD among nurses. Therefore, to help alleviate their considerable MSD burden, a greater emphasis will need to be placed on job satisfaction, work organization, and occupational stress, as well as the more traditional hazard reduction strategies such as manual handling, work tasks, and other occupational factors.