Development of an ergonomics risk assessment tool for repetitive task assessment (RTRA).

BACKGROUND: Most ergonomics assessment tools for repetitive task have been used in industries which are mainly focused on assessing the biomechanical risk factors that affect musculoskeletal disorders (MSDs) rather than the psychosocial and work environment risk factors. OBJECTIVE: To develop a tool for Repetitive Task Risk Assessment (RTRA) and Rapid Upper Limb Assessment (RULA) that can identify biomechanical, physical stress and psychosocial risk factors, prioritize risk reduction action and systematic record keeping. METHODS: The study consisted of 2 phases; tool development and evaluation of the contents of risk factors by 7 ergonomic experts and intra-rater and inter-rater reliability and validity tests of the tool by 1 researcher and 9 Thai practitioners to assess 30 repetitive tasks. RESULTS: RULA was modified by adding more biomechanical risk, combining psychosocial and work environment risk factors lead to MSD become the first prototype of RTRA. The Item-Objective Congruence Index (IOC) validated 20 items on usability of each step of the RTRA ranged between 0.64 and 0.93. The examination of the overall intra-rater reliability was 0.932 (95% CI: 0.862-0.967) and the overall inter-rater was 0.956 (95% CI: 0.909-0.978). CONCLUSION: The tool has high test-retest reliability. There is a suggestion for researchers to understand more on the identification of multiple risk factors in one assessment tool and consider a risk-level rating and scoring for prioritizing risk reduction.

Comparison of musculoskeletal load using two devices for manual height adjustment of the hospital bed.

Objectives. Patient manual handling in bed causes lower back pain (LBP) among Thai nurses. This study aims to develop an extension device for manual height adjustment of the hospital bed, and to evaluate its efficiency in preventing LBP among Thai nurses. Methods. Eleven participants were enrolled for electromyography measurement in eight right muscles. Subsequently, 56 volunteer nurses were recruited by convenience sampling for observational risk assessment by rapid entire body assessment (REBA) and satisfaction evaluation. The characteristics of the participants, percentage of maximum voluntary contraction (%MVC) of each muscle, REBA scores and satisfaction in using the device were analyzed by descriptive statistics, multivariate analysis of variance, paired t test and Wilcoxon signed-rank test, respectively. Results. %MVC values of the six muscles, i.e., biceps brachii, deltoideus, trapezius, latissimus dorsi, erector spinae and hamstring, were found to have a 4-18% decrease. The REBA scores decreased for both left and right when using the extension device, and all participants were more satisfied with the extension device than the hand crank of the hospital bed. Conclusions. The use of the extension device for manual height adjustment of the hospital bed developed from this study helps to prevent LBP among healthcare workers across settings.

Diarrheal knowledge and preventative behaviors among the caregivers of children under 5 years of age on the Tonle Sap Lake, Cambodia.

PURPOSE: Although Cambodia has made significant progress toward lowering the under-five mortality rate since 2000, diarrhea still accounts for 6% of the total number of these deaths. A vast majority of these deaths is preventable. In this study, we sought to examine diarrheal knowledge and preventative behaviors of caregivers of children under the age of 5 years, to determine caregiver factors associated with knowledge and behavior scores. PATIENTS AND METHODS: This was a cross-sectional household-level study conducted in two floating villages on the Tonle Sap Lake, Cambodia between January and February 2014. Caregivers of children under 5 years of age in the villages of Steung Trov and Moat Khla were asked 31 true or false questions to assess their knowledge of diarrhea. They also filled out a questionnaire to assess diarrhea preventative behaviors (DPBs). Comparison of mean scores to categorical caregiver variables was performed using one-way ANOVA analysis. Spearman's rank correlation was applied to identify the relationship between the knowledge and preventative behavior scores and independent quantitative variables. RESULTS: A total of 101 caregivers of 161 children under 5 years of age were interviewed. The majority of them (85.1%) was classified as having good knowledge and scored >80% on the assessment. Those with Khmer ethnicity (mean=28.10) scored significantly higher than those with Vietnamese ethnicity (mean 26.00; p=0.004). Older age was correlated with higher knowledge scores (ρ=0.2260; p=0.023) and DPB scores (ρ=0.2320; p=0.019). Significant differences were found between the DPB score and ethnicity, educational background, and wealth (p<0.01). CONCLUSION: Although the majority of caregivers had high diarrheal knowledge scores, preventative behaviors for diarrhea as assessed by this study were poor among almost all study participants. Vietnamese, wealthier, older, and more educated participants had better prevention scores. Future interventions in this remote region may benefit from these data as a guide to determine which specific preventative behaviors should be targeted.

Maternal return to paid work and breastfeeding practices in Bangkok, Thailand.

This study explored the association between mothers' work-related factors and breastfeeding practices in Bangkok, Thailand. Data were collected from 84 working mothers with a child aged 6 to 24 months who visited the breastfeeding mobile clinic at a nursery goods exhibition. Thai interviewers collected data using a structured questionnaire. Analysis of the data showed that exclusive breastfeeding for 3 months was 78.6%, and for 6 months it was 38.1%. Mothers who returned to work 3 months or more after giving birth exclusively breastfed more than the mothers who returned to work in less than 3 months (crude odds ratio [OR] = 4.26, 95% confidence interval [CI] = 1.39-13.05; adjusted OR = 4.15, 95% CI = 1.15-14.95). Moreover, mothers who worked at self-employed or family-owned businesses and some mothers working at private companies showed tendencies of returning to work in less than 3 months. Results suggest that longer maternity leave would help extend the duration of exclusive breastfeeding. In addition, the improvement of a breastfeeding supportive environment in the workplace would be valuable and may be an effective means to improve breastfeeding practices and infant health.

A multilevel study of smoking among youths in school at Buriram Province.

OBJECTIVE: The purpose of this cross-sectional study was to determine status of smoking among youths in school and to identify both student-level and school-level factors on smoking. MATERIAL AND METHOD: A stratified two stage cluster sampling was employed to recruit 2,557 students in grades 10-12 and 30 teachers from 30 high schools in academic years 2010 in Buriram province, using a multilevel logistic analysis. RESULTS: The current smoking status was 9.0% overall, 19.0% and 1.3% for male and female respectively. The results from multilevel logistic analysis revealed that only 10.5% of variation in smoking was associated with difference in school characteristics. The following student-level factors entered into the multilevel logistic regression model according to their importance were self-efficacy-with the moderate and low self-efficacy having a higher risk of smoking compared with high (OR 8.76, 5.80)-alcohol drinking (OR 5.42). Males were more likely to smoke than females (OR 4.56), perceived benefit on non-smoking-with the moderate and low perception having a greater chance of smoking compared with the higher level of perception (OR 2.31, 1.93). School-level factors including type of school, health promoting school policy, student-teacher ratio, proportion of teachers who smoked and availability of cigarettes near the school were also taken into account, but were not related to the status of smoking among the students. CONCLUSION: The present study confirmed that school factors had no significant relationship to smoking among youths. Strict smoke-free policy at school is recommended. School program should focus more on self-efficacy Social marketing campaign/ education should focus on friends and family as non-smoking role models.

Chewing of betel quid: why do health careproviders in Thimphu, Bhutan, do it?

OBJECTIVE: This cross-sectional study aimed to determine the prevalence of betel quid chewing and related factors including general characteristics, behavioral pattern, perception and social influences among health care providers in Thimphu, Bhutan. MATERIAL AND METHOD: A self-administered questionnaire was handed to 478 health care providers working in different units of health care centers in Thimphu during June-July 2010. A total of 391 (81.8%) questionnaires were returned. Chi-square test and multiple logistic regression were applied. RESULTS: The prevalence of current betel quid chewers among this group was 26.6%. Males chewed betel quid more than females (29.5%, 23.9% respectively). Forty-two percent of current chewers had no specific reasons for chewing betel quid, although 18.2% declared that they were addicted. Both friends and family members were key persons involved in influencing betel quid chewing. Marital status was significantly associated with betel quid chewing, married health care providers being 2 times more likely to chew betel quid (OR = 2.09, 95% CI = 1.02-4.28) than those of single marital status. Similarly, those coming from West Bhutan, were 2 times more likely to be currently using betel quid (OR = 2.71, 95% CI = 1.32-5.55) than other regions. Health care providers from families with more than half of their members chewing betel quid were 14 times more likely to be currently chewing it (OR = 14.52, 95% CI = 6.02-35.04) than families having none of their members chewing it. Health care smokers were more likely to chew betel quid than non-smoking ones (p-value = 0.012). Also occasional drinkers were 3 times more likely to be currently using betel quid (OR = 3.52, 95% CI = 1.78-6.96). Those who perceived a high barrier to quit chewing were about 2.6 times more likely to be current chewers of betel quid, than those who perceived less of a barrier to quit (OR = 2.62, 95% CI = 1.21-5.67). CONCLUSION: The present study revealed betel quid chewing prevalence rate of 26.6%. Of the various factors considered under study, marital status, region of origin, family members chewing betel quid, status of smoking and drinking were statistically proven significant.

Dengue risk factors and community participation in Binh Thuan Province, Vietnam, a household survey.

To look for risk factors for dengue and community participation in dengue control in Binh Thuan Province, Vietnam, three communes with a low incidence of dengue and three with a high incidence, in Binh Thuan Province, were compared. Knowledge, perception and preventive practice of dengue were measured by means of a structured questionnaire. A check list of environmental observations was used to evaluate environmental factors. Focus group discussion was conducted to evaluate perceptions of key factors for dengue vector control and community participation. One hundred ninety households in 6 communes were included in the study. Several statistically significant differences between low and high incidence communities were identified. The factors associated with a higher risk of dengue fever on the logistic regression were occupation (farmer) (RR 7.94; 95% CI 2.29-27.55), number of children less than 15 years old in the household (RR 1.54; 95% CI 1.06-2.23), no experience with dengue fever in the household (RR 2.334; 95% CI 1.12- 4.88), a garden near the house (RR 2.22; 95% CI 1.18-4.17) and water containers having mosquito larvae (RR 1.64; 95% CI 1.02-2.62). Television was the most important source of information. There were differences in risk factors for dengue among communes with low and high incidences. Communication regarding dengue prevention should be improved in high incidence communes. Community participation in dengue vector control should be promoted to make the dengue control programs more efficient with greater coordination of resources.

Behaviors and perceptions of Japanese tourists affecting diarrheal illness and health care need assessment: A questionnaire study.

OBJECTIVES: To measure the prevalence rate of, and determine the association between food and drink related behaviors and diarrheal illness among Japanese tourists, and assess their health care needs. METHODS: Eligible Japanese tourists (1,480) aged ≥15 years traveling in Chiangmai Province in the north, Ayutthaya Province in the center, Kanchanaburi Province in the west, Pattaya City in the east, and Krabi Province in the south of Thailand were enrolled in the study. Of these tourists, 1,318 consented to participate in this study and completed questionnaires in Japanese, giving a response rate of 89.1%. RESULTS: Among these Japanese tourists 21.3% had diarrheal illness, and of these tourists, 5.0% had classical travelers' diarrhea (TD), 11.8% had mild TD, 3.3% had good food and drink related behaviors, and 75.4% had moderate level of perception of diarrhea related to drinking and eating. Multiple logistic regression analysis indicated three significant diarrheal illness predictors: large number of previous visits to Thailand, longer stay in Thailand, and the experience of visiting other countries. Furthermore, 56.9% suggested providing an adequate number of toilets at tourist destinations; 53.9% suggested providing a 24-hour emergency call facility for a public ambulance; and 51.9% suggested providing garbage bins and garbage disposal facilities at tourist destinations. CONCLUSIONS: TD still affects experienced Japanese tourists who visit Thailand. Although the proportions of the good levels of food and drink related behaviors were low, there were indications that Japanese tourists perceived the risk of contracting TD.

Rational drug use in Cambodia: study of three pilot health centers in Kampong Thom Province.

This study obtained baseline information for the design of a strategy to address irrational prescribing practices in three health centers in Kampong Thom Province, Cambodia. Indicators of rational drug use have been measured and compared with Standard Guidelines. Data were collected from patients' registers and by interviewing patients immediately after patient-prescriber and patient-dispenser encounters. Checklists and pre-designed forms were used to collect data regarding the World Health Organization drug use indicators and some additional indices. Of the 330 prescriptions analyzed, the results showed that the average number of drugs per prescription was 2.35 and that a large proportion of the prescriptions contained two or more drugs that could result in adverse drug interactions. Prescribing by generic names (99.8%) was encouraging. The exposure of patients to antibiotics (66% to 100%) was high, and injection use (2.4%) was often unnecessary. Prescribing from the Essential Drugs List (99.7%) was satisfactory. The average consultation and dispensing times were short and not sufficient for patients to get health information. All the prescribed drugs were supplied, but all were inadequately labeled. Some 55% of patients knew the correct dosage of their drugs. The availability of key essential drugs (86.6%) was below the Standard. The percentages of appropriate prescriptions for treating malaria, diarrhea and acute respiratory infection treatment were 68.3%, 3.3%, and 45%, respectively. Inappropriate prescriptions were mostly due to unsuitable dosages, incorrect drugs, and the improper duration of treatment. The results suggest a need for intervention to curb the irrational use of drugs in prescribing at the three pilot health centers. Continuing education of prescribers and healthcare providers, monitoring, supervision, public education would be beneficial.