Importance of stoma care nurses in preparing patients for stoma surgery and adjustment to life with a stoma.

BACKGROUND: Stoma surgery is a life-changing event and patients must subsequently make significant adjustments to their lives. AIM: The study set out to understand the level of interaction between patients and stoma care nurses (SCNs) in relation to preparing patients for stoma surgery and in adjustment to life with a stoma. METHODS: Retrospective, self-reported questionnaires for patients and SCNs. FINDINGS: Most patients (98%) with planned stoma surgery had pre-operative consultations with health professionals in contrast to 36% of patients with unplanned surgery, who did not. One third of patients with unplanned surgery did not feel prepared for life with a stoma based on the information provided during their hospital stay. Two thirds of the nurses reported having sufficient time to prepare patients for stoma surgery and to life with a stoma. CONCLUSION: SCNs are key in preparing patients for surgery and for life with a stoma. Variations in care were experienced by patients having planned versus unplanned surgeries.

Evaluating the Performance and Perception of a Stoma Bag Full-Circle Filter in People with a Colostomy or an Ileostomy-Two Randomized Crossover Trials.

Stoma bag filter-related issues, such as ballooning (the bag filling with gas), remain highly prevalent among users. The full-circle filter was purposely designed to reduce ballooning through the inclusion of a unique, full-circle pre-filter. Two similar randomized crossover trials were conducted to compare the performance of the full-circle filter with a dual filter in adults with a colostomy (n = 20) or an ileostomy (n = 20). The frequency of ballooning was significantly lower with the full-circle filter versus the dual filter in participants with a colostomy (p < 0.0007) and in participants with an ileostomy (p < 0.0001). No significant differences were observed in the frequency of other issues (pancaking, odor problems, and ostomy solution discretion) between the filters. On average, participants with an ileostomy wore ostomy solutions with the full-circle filter for 3.3 h longer than ostomy solutions with the dual filter (p < 0.0001); wear-time in users with a colostomy was comparable between the filters. Considering the lack of published research on stoma bag filters and the high prevalence of filter-related issues, these data provide important information for health care practitioners who support people living with a stoma.

Influence of Wearing Ballistic Vests on Physical Performance of Danish Police Officers: A Cross-Over Study.

PURPOSE: We aimed to investigate the influence of wearing a ballistic vest on physical performance in police officers. METHODS: We performed a cross-over study to investigate the influence of wearing a ballistic vest on reaction and response time, lumbar muscle endurance and police vehicle entry and exit times. Reaction and response time was based on a perturbation setup where the officers' pelvises were fixed and EMG of lumbar and abdominal muscles was recorded. We used a modified Biering-Sørensen test to assess the lumbar muscle endurance and measured duration of entry and exit maneuvers in a variety of standard-issue police cars. RESULTS: There was a significant difference of 24% in the lumbar muscle endurance test (no vest: 151 s vs. vest: 117 s), and the police officers experienced higher physical fatigue after the test when wearing a vest. Furthermore, officers took longer to both enter and exit police cars when wearing a vest (range: 0.24-0.56 s) depending on the model of the vehicle. There were no significant differences in reaction and response times between the test conditions (with/without vest). DISCUSSION AND CONCLUSION: Wearing of a ballistic vest significantly influenced the speed of movement in entry and exit of police cars and lumbar muscle endurance, although it does not seem to affect reaction or response times. The ballistic vest seems to impair performance of tasks that require maximal effort, which calls for better designs of such vests.

Occupational lifting predicts hospital admission due to low back pain in a cohort of airport baggage handlers.

PURPOSE: To examine if occupational lifting assessed as cumulative years as a baggage handler is associated with first-time hospital diagnosis or treatment for low back disorders. METHODS: This study is based on the Copenhagen Airport Cohort consisting of male baggage handlers performing heavy lifting every day and a reference group of unskilled men from the greater Copenhagen area during the period 1990-2012. We followed the cohort in the National Patient Register and Civil Registration System to obtain information on diagnoses, surgery, mortality, and migration. The outcomes were first-time hospital diagnosis or surgery for (1) lumbar disc herniation or (2) low back pain (LBP). RESULTS: Baggage handlers (N = 3473) had a higher incidence rate of LBP, but not of lumbar disc herniation, compared to the reference group (N = 65,702). Baggage handlers with longer employment had a higher incidence of LBP compared to baggage handlers with shorter employment. The linear association of cumulative years as a baggage handler on LBP was significantly increased with an incidence rate ratio of 1.16 (95% CI 1.07-1.25) for a 5-year increase of employment as baggage handler. CONCLUSIONS: In this large cohort study, we found an increased incidence of LBP among baggage handlers compared to the reference group with indications of a dose-response relationship between years of employment and the outcome. For baggage handlers working on the apron, the incidence was particularly increased before introduction of technical lifting equipment, suggesting that preventive measures to reduce cumulative work load may have a positive effect.

Knee osteoarthritis among airport baggage handlers: A prospective cohort study.

BACKGROUND: Knee osteoarthritis is a common and often disabling disorder, which has been related to knee-straining work. However, exposure response relations are uncertain and there are few prospective studies. We studied prospectively if incident knee osteoarthritis is associated with cumulative exposure as an airport baggage handler, lifting on average 5000 kg/d. METHODS: The study is based on the Copenhagen Airport Cohort, a historical cohort of male baggage handlers and a reference group of unskilled men from the greater Copenhagen area, followed from 1990 to 2012. Cumulative years of employment as a baggage handler was based on information from company employment and union registers. Outcome was first hospital admission with a discharge diagnosis of knee osteoarthritis and/or knee replacement, ascertained from the Danish National Patient Register. RESULTS: The cohort contained 3442 baggage handlers and 65 511 workers in the reference group. The unadjusted incidence rate ratio (IRR) of knee osteoarthritis increased steeply with cumulative years as a baggage handler. Although the exposure-response pattern became weaker and statistically nonsignificant (P ≈ .10) when adjusting for age, the risk of knee osteoarthritis was still increased in baggage handlers at the highest exposure level. Additional analyses showed that the association between age and osteoarthritis was stronger for baggage handlers (IRR = 2.09; 95% CI: 1.68-2.60) than for referents (IRR = 1.58; 95% CI: 1.53-1.63), indicating that knee osteoarthritis occurred at a younger age among baggage handlers than in the reference group. CONCLUSIONS: The results of this prospective cohort study support that long-term heavy lifting increases the risk of knee osteoarthritis.

Risk of subacromial shoulder disorder in airport baggage handlers: combining duration and intensity of musculoskeletal shoulder loads.

Musculoskeletal shoulder load among baggage handlers measured by combining duration and intensity based on biomechanical and epidemiological information may be a stronger predictor of subacromial shoulder disorders than baggage handler seniority. In 2012, a cohort of baggage handlers employed at Copenhagen Airport in 1990-2012, and a cohort of unskilled otherwise employed men answered a survey. Self-reported information on work tasks during employment in the airport in combination with work task specific biomechanically modelled forces in the shoulder joint was used to estimate shoulder load. Exposure measures were accumulated shoulder abduction moment, accumulated shoulder compression force, accumulated supraspinatus force and baggage handler seniority. The outcome was subacromial shoulder disorder registered in the Danish National Patient Register. When analyses were adjusted by all confounders except age, exposure variables showed close to significant associations with subacromial shoulder disorder. Results could not confirm our hypothesis that combined information on work task duration and shoulder load intensity was stronger associated with subacromial shoulder disorder than seniority. Practitioner Summary: In this study we sought to identify if the exposure to work-related musculoskeletal shoulder loading including duration and intensity among baggage handlers was associated with subacromial shoulder disorder. We found that there was an association but this was not stronger than that between baggage handler seniority and subacromial shoulder disorder.

The effect of telepsychiatric modalities on reduction of readmissions in psychiatric settings: A systematic review.

Introduction Telepsychiatric modalities are used widely in the treatment of many mental illnesses. It has also been proposed that telepsychiatric modalities could be a way to reduce readmissions. The purpose of the study was to conduct a systematic review of the literature on the effects of telepsychiatric modalities on readmissions in psychiatric settings. Methods We conducted a systematic literature search in MEDLINE, CINAHL, Embase, Cochrane, PsycINFO and Joanna Briggs databases in October 2015. Inclusion criteria were (a) patients with a psychiatric diagnosis, (b) telepsychiatric interventions and (c) an outcome related to readmission. Results The database search identified 218 potential studies, of which eight were eligible for the review. Studies were of varying quality and there was a tendency towards low-quality studies (five studies) which found positive outcomes regarding readmission, whereas the more methodological sound studies (three studies) found no effect of telepsychiatric modalities on readmission rates. Discussion Previous studies have proven the effectiveness of telepsychiatric modalities in the treatment of various mental illnesses. However, in the present systematic review we were unable to find an effect of telepsychiatric modalities on the rate of readmission. Some studies found a reduced rate of readmissions, but the poor methodological quality make the findings questionable. At the present time there is no evidence to support the use of telepsychiatry due to heterogeneous interventions, heterogeneous patient groups and lack of high-quality studies.

Copenhagen Airport Cohort: air pollution, manual baggage handling and health.

PURPOSE: Copenhagen Airport Cohort 1990-2012 presents a unique data source for studies of health effects of occupational exposure to air pollution (ultrafine particles) and manual baggage handling among airport employees. We describe the extent of information in the cohort and in the follow-up based on data linkage to the comprehensive Danish nationwide health registers. In the cohort, all information is linked to the personal identification number that also is used in Denmark Statistics demographic and socioeconomic databases and in the nationwide health registers. PARTICIPANTS: The cohort covers 69 175 men in unskilled positions. The exposed cohort includes men in unskilled jobs employed at Copenhagen Airport in the period 1990-2012 either as baggage handlers or in other outdoor work. The reference cohort includes men in unskilled jobs working in the greater Copenhagen area. FINDINGS TO DATE: The cohort includes environmental Global Positioning System (GPS) measurements in Copenhagen Airport, information on job function/task for each calendar year of employment between 1990 and 2012, exposure to air pollution at residence, average weight of baggage lifted per day and lifestyle. By linkage to registers, we retrieved socioeconomic and demographic data and data on healthcare contacts, drug subscriptions, incident cancer and mortality. FUTURE PLANS: The size of the cohort and the completeness of the register-based follow-up allow a more accurate assessment of the possible health risks of occupational exposure to ultrafine particles and manual baggage handling at airports than in previous studies. We plan to follow the cohort for the incidence of ischaemic heart diseases, cerebrovascular disease, lung and bladder cancer, asthma and chronic obstructive pulmonary disease, and further for associations between heavy manual baggage handling and musculoskeletal disorders. TRIAL REGISTRATION: number 2012-41-0199.

A Cohort Study on Meniscal Lesions among Airport Baggage Handlers.

Meniscal lesions are common and may contribute to the development of knee arthrosis. A few case-control and cross-sectional studies have identified knee-straining work as risk factors for meniscal lesions, but exposure-response relations and the role of specific exposures are uncertain, and previous results may be sensitive to reporting and selection bias. We examined the relation between meniscal lesions and cumulative exposure to heavy lifting in a prospective register-based study with complete follow-up and independent information on exposure and outcome. We established a cohort of unskilled men employed at Copenhagen Airport or in other companies in the metropolitan Copenhagen area from 1990 to 2012 (the Copenhagen Airport Cohort). The cohort at risk included 3,307 airport baggage handlers with heavy lifting and kneeling or squatting work tasks and 63,934 referents with a similar socioeconomic background and less knee-straining work. Baggage handlers lifted suitcases with an average weight of approximately 15 kg, in total approximately five tonnes during a 9-hour workday. The cohort was followed in the National Patient Register and Civil Registration System. The outcome was a first time hospital diagnosis or surgery of a meniscal lesion. Baggage handlers had a higher incidence of meniscal lesions than the referents. Within baggage handlers spline regression showed that the incidence rate ratio was 1.91 (95% confidence interval: 1.29-2.84) after five years as a baggage handler and then decreased slowly to reach unity after approximately 30 years, adjusted for effects of potential confounders. This relation between baggage handling and meniscal lesions was present for work on the apron which involves lifting in a kneeling or squatting position, but not in the baggage hall, which only involves lifting in standing positions. The results support that long-term heavy lifting in a kneeling or squatting position is a risk factor for the development of symptomatic meniscal lesions.

Low back load in airport baggage handlers.

Low back pain (LBP) constitutes a major economic problem in many countries. The causes of LBP are still largely unknown and several risk factors have been suggested including heavy lifting, which causes high compression forces of the tissues in the low back. Micro-fractures in the endplates of the vertebrae caused by compression forces have been suggested as a source of unspecific pain. Although airport baggage handlers exhibit a high prevalence of musculoskeletal complaints the amount of biomechanical research within this and similar areas is limited. The aims of this thesis were to perform a general description of the lumbar loading in baggage handlers (Paper I), to develop a generically useful tool to examine specific lumbar compression in a valid manner (Paper II & III), and to investigate the spinal loading in common work tasks for baggage handlers. (Paper III). We recorded electromyography during baggage handling in the baggage hall, by a conveyor, and inside the aircraft baggage compartment. Electromyography was analyzed using amplitude probability distribution functions (APDF) on both tasks and full day recordings and root mean square (RMS) values on tasks. Furthermore, we estimated L4/L5 compression and moment along with shoulder flexor moment with a Watbak model based on more specific subtasks. In addition, we built an inverse dynamics-based musculoskeletal computer model using the AnyBody Modeling System (AMS). Motion capture recorded the movements in 3D during a stooped and a kneeling lifting task simulating airport baggage handler work. Marker trajectories were used to drive the model. The AMS-models computed estimated compression forces, shear forces and the moments around the L4/L5 joint. The compression forces were used for comparison with the vertebral compression tolerances reported in the literature. The RMS muscle activity was high in all tasks. The average peak RMS muscle activity was up to 120% EMGmax in the erector spinae during the baggage hall task. There were no significant differences between the tasks in the APDF analyses. The L4/L5 compression and extensor moment from Watbak were significantly higher in the baggage compartment task than in both the conveyor and baggage hall tasks. The stooped lifting task produced 5,541 N compression in the L4/L5 joint and a kneeling task produced 4,197 N in the AMS models. These compression forces were close to the average compression tolerance and exceed the recommended limits for compression during lifting.

Subacromial shoulder disorders among baggage handlers: an observational cohort study.

PURPOSE: To assess the influence of cumulative employment as baggage handler on the risk of incident subacromial shoulder disorders. Baggage handling is characterized by repetitive work primarily consisting of heavy lifting in awkward positions and time pressure. METHODS: This cohort study is based on the Copenhagen Airport Cohort consisting of unskilled men with employment at Copenhagen Airport and unskilled men with employment in other firms in the Greater Copenhagen area during the period 1990-2012. Only men were included. We followed the cohort in the National Patient Register and Civil Registration System. The primary exposure was cumulative years of employment as a baggage handler, and the primary outcome was diagnoses and surgical treatment of subacromial shoulder disorders. RESULTS: The cohort contained 3396 baggage handlers and 63,909 workers in the reference group. Baggage handlers with longer cumulative years of employment had higher incidence compared to baggage handlers with shorter employment; for example, baggage handlers with 10-19 years of employment had incidence rate ratio of 2.07 (95 % confidence interval, 1.27-3.38) compared to baggage handlers with less than 3 years of employment. Spline regression showed an increase in incidence within the first few years after employment whereupon the increased risk remained constant for longer employment. Baggage handlers had increased incidence in younger ages than the reference population. CONCLUSIONS: In this large cohort study, we found increased incidence of subacromial shoulder disorders for workers with longer cumulative years of employment. These results support that long-term lifting in awkward positions and time pressure influences the risk of subacromial shoulder disorders.

Markerless motion capture can provide reliable 3D gait kinematics in the sagittal and frontal plane.

Estimating 3D joint rotations in the lower extremities accurately and reliably remains unresolved in markerless motion capture, despite extensive studies in the past decades. The main problems have been ascribed to the limited accuracy of the 3D reconstructions. Accordingly, the purpose of the present study was to develop a new approach based on highly detailed 3D reconstructions in combination with a translational and rotational unconstrained articulated model. The highly detailed 3D reconstructions were synthesized from an eight camera setup using a stereo vision approach. The subject specific articulated model was generated with three rotational and three translational degrees of freedom for each limb segment and without any constraints to the range of motion. This approach was tested on 3D gait analysis and compared to a marker based method. The experiment included ten healthy subjects in whom hip, knee and ankle joint were analysed. Flexion/extension angles as well as hip abduction/adduction closely resembled those obtained from the marker based system. However, the internal/external rotations, knee abduction/adduction and ankle inversion/eversion were less reliable.

Sex differences in muscular load among house painters performing identical work tasks.

PURPOSE: The present study aimed to estimate possible differences in upper body muscular load between male and female house painters performing identical work tasks. Sex-related differences in muscular load may help explain why women, in general, have more musculoskeletal complaints than men. METHODS: In a laboratory setting, 16 male and 16 female house painters performed nine standardised work tasks common to house painters. Unilateral electromyography (EMG) recordings were obtained from the supraspinatus muscle by intramuscular electrodes and from the trapezius, extensor and flexor carpi radialis muscles by surface electrodes. Relative muscular loads in %EMGmax as well as exerted force in Newton, based on ramp calibrations, were assessed. Sex differences were tested using a mixed model approach. RESULTS: Women worked at about 50% higher relative muscular loads than men in the supraspinatus and forearm muscles at all percentiles and in all tasks. Women exerted about 30% less force in the trapezius muscle at the 50th percentile. CONCLUSIONS: Female house painters had a higher relative muscular load than their male colleagues without exerting more force. The effects of a higher relative muscular load accumulated over years of work may in part explain why musculoskeletal complaints in the upper body occur more frequently among women than men.

Baggage handler seniority and musculoskeletal symptoms: is heavy lifting in awkward positions associated with the risk of pain?

OBJECTIVES: Heavy lifting is associated with musculoskeletal disorders but it is unclear whether it is related to acute reversible effects or to chronic effects from cumulated exposure. The aim of this study was to examine whether musculoskeletal symptoms in Danish airport baggage handlers were associated with their seniority as baggage handler, indicating chronic effects from cumulated workload. METHODS: We established a group of baggage handlers employed at Copenhagen Airport during the period 1983-2012 (n=3092) and a reference group of men in other unskilled occupations with less heavy work (n=2478). Data regarding work history, lifestyle and musculoskeletal symptoms were collected using a self-administered questionnaire (response rate 70.1% among baggage handlers and 68.8% among the reference group). RESULTS: The ORs of self-reported musculoskeletal symptoms during the last 12 months in the neck/upper back, lower back, shoulders, elbows, wrists, hips and knees were significantly higher in baggage handlers than in the reference group. These differences were explained by significant linear effects of baggage handler seniority for six anatomical regions. Adjustment for age, body mass index, smoking and leisure-time physical activity did not change these results. The findings were stable over age strata and among present and former baggage handlers. CONCLUSIONS: The risk of musculoskeletal symptoms in six anatomical regions increased with increasing seniority as a baggage handler. This is consistent with the assumption that cumulated heavy lifting may cause chronic or long-lasting musculoskeletal symptoms. However, we cannot exclude that other factors related to baggage handler seniority may explain some of the associations.

The effect of foot progression angle on knee joint compression force during walking.

It is unclear how rotations of the lower limb affect the knee joint compression forces during walking. Increases in the frontal plane knee moment have been reported when walking with internally rotated feet and a decrease when walking with externally rotated feet. The aim of this study was to investigate the knee joint compressive forces during walking with internal, external and normal foot rotation and to determine if the frontal plane knee joint moment is an adequate surrogate for the compression forces in the medial and lateral knee joint compartments under such gait modifications. Ten healthy males walked at a fixed speed of 4.5 km/h under three conditions: Normal walking, internally rotated and externally rotated. All gait trials were recorded by six infrared cameras. Net joint moments were calculated by 3D inverse dynamics. The results revealed that the medial knee joint compartment compression force increased during external foot rotation and the lateral knee joint compartment compression force increased during internal foot rotation. The increases in joint loads may be a result of increased knee flexion angles. Further, these data suggest that the frontal plane knee joint moment is not a valid surrogate measure for knee joint compression forces but rather indicates the medial- to-lateral load distribution.