A scoping review of workplace wellness audit tools assessing physical activity and sedentary behaviour.

BACKGROUND: Regular physical inactivity and excessive sedentary behaviour are public and population health concerns. The workplace is an ideal health promotion intervention setting to support employees, particularly office workers. Workplace assessments are a critical component of workplace health promotion programming. The aim of this project was to conduct a scoping review to systematically identify and describe workplace audit tools that assess physical activity and sedentary behaviour influences, as two independent behaviours, through a social ecological lens. METHODS: Fourteen electronic databases were searched for academic literature and 69 web-based resources were searched for grey literature in May 2017. English language workplace audit tools with items on physical activity or sedentary behaviour established in western countries were included. Key characteristics (ie, aim, type, health behaviour, validity, reliability and theory/model/framework) of the audit tools, checklists or questionnaires for office-based workplaces were identified, described and summarised. RESULTS: The scoping review identified 21 relevant tools. Most tools focused on physical activity alone and did not address sedentary behaviour as a distinct behaviour. Few tools included items assessing physical activity and sedentary behaviour influences across multiple levels of the social ecological model. The most common social ecological focuses in the tools were policy and environmental influences. CONCLUSIONS: Numerous workplace physical activity and/or sedentary behaviour audit tools were available. However, a gap was identified as tools and resources that assess and support organisational changes to influence physical activity and sedentary behaviour as two independent health behaviours across multiple social ecological levels within the workplace had not been developed.

Can a redesign of emergency pharmacist roles improve medication management? A prospective study in three Australian hospitals.

BACKGROUND: Emergency departments (EDs) face increasing service demands and the imposition of treatment targets which has led to continual process redesign and changes in staff skill mix and functions. OBJECTIVE: To identify extended ED pharmacist roles that could improve medication management and to implement and evaluate one such role change. METHODS: A focus group of clinicians sought to redesign processes around ED medication management. Preparation of medication charts for patients admitted from ED was selected. Baseline data were obtained to define elements of existing medication charting processes. Suitably trained ED pharmacists' trialled the effectiveness of making therapeutic suggestions on a medication chart 'sticker' or by direct 'consultation' with medical staff. At the conclusion of the study focus groups at each site evaluated clinical staff perceptions of the change. RESULTS: Focus group participants thought that ED pharmacists could undertake extended roles in analgesia, nausea control, antibiotic cover, addiction management and preparation of medication charts for admitted patients. In the pre-intervention audit (n = 140), 74% required at least one intervention by the ward pharmacists to address medication discrepancies. Ward pharmacists detected 292 medication discrepancies (median 1, IQR 0-3). In the 'sticker' intervention the ED pharmacist made 84 therapeutic suggestions of which 66 (78.6%) were accepted by medical staff. In the 'consultation' intervention 230 therapeutic suggestions were made of which 219 (95.2%) were accepted. The qualitative evaluation found that pharmacist-prepared medication charts within the processes established were deemed safe, timely, accurate, complete and legible. CONCLUSION: Support exists for ED pharmacists to expand their medication-related roles. ED pharmacists can safely prepare medication charts in a timely fashion and their therapeutic suggestions within a 'consultative' framework are more beneficial than written advice. However, issues relating to resourcing, hours of service, service focus, statutory restrictions and training support for extended roles require resolution.

Agreement between virtual and in-the-field environmental audits of assisted living sites.

The authors investigated the use of Google Earth's Street View option to audit the presence of built environment features that support older adults' walking. Two raters conducted virtual (Street View) and in-the-field audits of 48 street segments surrounding urban and suburban assisted living sites in metropolitan Vancouver, BC, Canada. The authors determined agreement using absolute agreement. Their findings indicate that Street View may identify the presence of features that promote older adults' walking, including sidewalks, benches, public washrooms, and destinations. However, Street View may not be as reliable as in-the-field audits to identify details associated with certain items, such as counts of trees or street lights; presence, features, and height of curb cuts; and sidewalk continuity, condition, and slope. Thus, the appropriateness of virtual audits to identify microscale built environment features associated with older adults' walking largely depends on the purpose of the audits-specifically, whether the measurer seeks to capture highly detailed features of the built environment.

Does an 'activity-permissive' workplace change office workers' sitting and activity time?

INTRODUCTION: To describe changes in workplace physical activity, and health-, and work-related outcomes, in workers who transitioned from a conventional to an 'activity-permissive' workplace. METHODS: A natural pre-post experiment conducted in Vancouver, Canada in 2011. A convenience sample of office-based workers (n=24, 75% women, mean [SD] age = 34.5 [8.1] years) were examined four months following relocation from a conventional workplace (pre) to a newly-constructed, purpose-built, movement-oriented physical environment (post). Workplace activity- (activPAL3-derived stepping, standing, and sitting time), health- (body composition and fasting cardio-metabolic blood profile), and work- (performance; job satisfaction) related outcomes were measured pre- and post-move and compared using paired t-tests. RESULTS: Pre-move, on average (mean [SD]) the majority of the day was spent sitting (364 [43.0] mins/8-hr workday), followed by standing (78.2 [32.1] mins/8-hr workday) and stepping (37.7 [15.6] mins/8-hr workday). The transition to the 'activity-permissive' workplace resulted in a significant increase in standing time (+18.5, 95% CI: 1.8, 35.2 mins/8-hr workday), likely driven by reduced sitting time (-19.7, 95% CI: -42.1, 2.8 mins/8-hr workday) rather than increased stepping time (+1.2, 95% CI: -6.2, 8.5 mins/8-hr workday). There were no statistically significant differences observed in health- or work-related outcomes. DISCUSSION: This novel, opportunistic study demonstrated that the broader workplace physical environment can beneficially impact on standing time in office workers. The long-term health and work-related benefits, and the influence of individual, organizational, and social factors on this change, requires further evaluation.

Exploring older adults' patterns and perceptions of exercise after hip fracture.

PURPOSE: To identify exercise patterns and perceived barriers, enablers, and motivators to engaging in exercise for older adults following hip fracture. METHOD: Telephone interviews were conducted with older adults (aged 62-97 y) within 1 year after hip fracture. Participants were asked about basic demographic information; level of mobility before hip fracture; current level of mobility; and barriers, enablers, and motivators to participating in exercise. RESULTS: A total of 32 older adults successfully recovering after hip fracture completed the telephone interviews. Participants reported few problems with their mobility, and all were engaging in exercise. There were few reported barriers to exercise; the most common were health-related concerns (pain, fatigue, illness, or injury). The most frequently reported enablers were intrinsic factors (determination, seeing improvements, and making exercise part of their daily routine); in particular, the most common motivator to exercise was recovery of function to improve mobility and complete daily and leisure activities. CONCLUSIONS: This study highlights the responses of a group of older adults recovering well after hip fracture. Older adults engage in exercise despite the potential limitations associated with a hip fracture. Participants' responses underscore the importance of intrinsic factors and suggest avenues for future investigation.

Objectif : Déterminer, chez les aînés, les modèles, les obstacles, les éléments facilitateurs et les facteurs de motivation à l'activité physique à la suite d'une fracture de la hanche. Méthode : Des entrevues téléphoniques ont été réalisées auprès d'adultes de 62 à 97 ans dans l'année qui a suivi leur fracture de la hanche. On a demandé aux participants des renseignements démographiques de base, leur degré de mobilité au moment de l'entrevue ainsi que les obstacles, les éléments qui facilitaient chez eux l'activité physique et ce qui les motivait à demeurer actifs. Résultats : Au total, 32 personnes ayant bien récupéré à la suite d'une fracture de la hanche ont répondu à l'entrevue téléphonique. Les participants ont fait part de légers problèmes de mobilité et tous faisaient de l'exercice. Peu d'obstacles à la pratique d'activité physique ont été signalés; les plus courants avaient trait à leur état de santé (douleur, fatigue, maladie ou blessure). Les éléments facilitateurs le plus souvent évoqués étaient des facteurs intrinsèques (détermination, perception d'une amélioration et exercice bien intégré aux habitudes quotidiennes); plus particulièrement, l'élément de motivation le plus courant relatif à l'exercice était le fait qu'il permettait de retrouver sa fonction afin d'améliorer sa mobilité, d'accomplir des tâches quotidiennes et de participer à des activités de loisir. Conclusions : Cette étude vient mettre en lumière les réponses d'un groupe d'aînés qui reprennent des forces à la suite d'une fracture de la hanche. Les aînés font de l'exercice malgré les limites possibles associées à une telle fracture. Les réponses des participants venaient souligner l'importance de facteurs intrinsèques et suggéraient des avenues d'investigation future.

Risk of hip fracture with hip or knee osteoarthritis: a systematic review.

Osteoarthritis (OA) and hip fracture are two common musculoskeletal disorders associated with substantial societal and personal burden. The objective of this systematic review was to determine the association between hip or knee OA and risk of hip fractures in people aged 45 years and older as compared to people aged 45 years and older who do not have OA. We searched CINAHL, Cochrane Database of Systematic Reviews, Embase, OVID Medline, PUBMED, and SCOPUS for studies published up to July 2010 and conducted forward searches of included studies using Web of Science. Two reviewers independently screened articles for inclusion, extracted data, and evaluated the risk of bias of included studies using the Newcastle-Ottawa Scale. Eleven articles were included. Three investigated individuals with knee OA, two included adults with knee or hip OA, and six investigated adults with hip OA. We did not combine the hip OA or the knee OA studies in a meta-analysis due to the heterogeneity in: study populations and covariates adjusted for in estimates of association. Hip OA may be related to a decreased risk of hip fracture when considering crude estimates of association or estimates of association adjusted for a limited number of covariates, although not all studies found support for the presence of this association. The association between knee OA and hip fracture remains unclear. The presence of OA in the hip or knee should not act as an indication that assessment for hip fracture risk is unnecessary.

Bone health and type 2 diabetes mellitus: a systematic review.

PURPOSE: To systematically review the literature related to bone health in older adults with type 2 diabetes mellitus (T2DM). METHODS: We conducted a systematic review of the literature from January 2005 until February 2010, using keywords related to T2DM and bone-health imaging technology in older adults (aged ≥60 years) to search PubMed, OVID MEDLINE, Ageline, CINAHL, Embase, and PsycINFO. RESULTS: We found a total of 13 studies that met the inclusion criteria for this review. The majority of the studies used dual X-ray absorptiometry (DXA) and showed either higher or similar areal bone mineral density (aBMD) for older adults with T2DM relative to healthy controls. Studies using more advanced imaging suggested that there may be differences in bone geometry between older adults with and without T2DM. CONCLUSIONS: Older adults with T2DM have similar or higher aBMD at the hip relative to older adults without T2DM, despite previous literature reporting an increased risk of low-trauma fractures. Recent studies with advanced imaging have suggested that there may be differences in bone geometry between older adults with T2DM and those without. Health professionals, especially physiotherapists, should be aware of the increased risk and include assessment of fall risk factors and exercise prescription for fall prevention for older adults with T2DM.

When healthcare workers get sick: exploring sickness absenteeism in British Columbia, Canada.

OBJECTIVE: To determine the demographic and work characteristics of healthcare workers who were more likely to take sickness absences from work in British Columbia, Canada. METHODS: Payroll data were analyzed for three health regions. Sickness absence rates were determined per person-year and then compared across demographic and work characteristics using multivariate Poisson regression models. The direct costs to the employer due to sickness absences were also estimated. RESULTS: Female, older, full-time workers, long-term care workers and those with a lower hourly wage were more likely to take sickness absences and had similar trends with respect to the costs due to sickness absence. For occupations, licensed practical nurses, care aides and facility support workers had higher rates of sickness absence. Registered nurses, and those workers paid high hourly wages were associated with highest sickness related costs. CONCLUSION: It is important to understand the demographic and work characteristics of those workers who are more likely to take sickness absences in order to make sure that they are not experiencing additional hazards at work or facing detrimental workplace conditions. Policy makers need to establish healthy, safe and in turn more productive workplaces. Further research is needed on how interventions can reduce sickness absence.

Evaluation of ceiling lifts in health care settings: patient outcome and perceptions.

Ceiling lifts have been introduced into health care settings to reduce manual patient lifting and thus occupational injuries. Although growing evidence supports the effectiveness of ceiling lifts, a paucity of research links indicators, such as quality of patient care or patient perceptions, to the use of these transfer devices. This study explored the relationship between ceiling lift coverage rates and measures of patient care quality (e.g., incidence of facility-acquired pressure ulcers, falls, urinary infections, urinary incontinence, and assaults [patient to staff] in acute and long-term care facilities), as well as patient perceptions of satisfaction with care received while using ceiling lifts in a complex care facility. Qualitative semi-structured interviews were used to generate data. A significant inverse relationship was found between pressure ulcer rates and ceiling lift coverage; however, this effect was attenuated by year. No significant relationships existed between ceiling lift coverage and patient outcome indicators after adding the "year" variable to the model. Patients generally approved of the use of ceiling lifts and recognized many of the benefits. Ceiling lifts are not detrimental to the quality of care received by patients, and patients prefer being transferred by ceiling lifts. The relationship between ceiling lift coverage and pressure ulcer rates warrants further investigation.

Evaluation of ceiling lifts: transfer time, patient comfort and staff perceptions.

Mechanical lifting devices have been developed to reduce healthcare worker injuries related to patient handling. The purpose of this study was to evaluate ceiling lifts in comparison to floor lifts based on transfer time, patient comfort and staff perceptions in three long-term care facilities with varying ceiling lift coverage. The time required to transfer or reposition patients along with patient comfort levels were recorded for 119 transfers. Transfers performed with ceiling lifts required on average less time (bed to chair transfers: 156.9 seconds for ceiling lift, 273.6 seconds for floor lift) and were found to be more comfortable for patients. In the three facilities, 143 healthcare workers were surveyed on their perceptions of patient handling tasks and equipment. For both transferring and repositioning tasks, staff preferred to use ceiling lifts and also found them to be less physically demanding. Further investigation is needed on repositioning tasks to ensure safe practice.

Near miss and minor occupational injury: Does it share a common causal pathway with major injury?

BACKGROUND: An essential assumption of injury prevention programs is the common cause hypothesis that the causal pathways of near misses and minor injuries are similar to those of major injuries. METHODS: The rates of near miss, minor injury and major injury of all reported incidents and musculoskeletal incidents (MSIs) were calculated for three health regions using information from a surveillance database and productive hours from payroll data. The relative distribution of individual causes and activities involved in near miss, minor injury and major injury were then compared. RESULTS: For all reported incidents, there were significant differences in the relative distribution of causes for near miss, minor, and major injury. However, the relative distribution of causes and activities involved in minor and major MSIs were similar. The top causes and activities involved were the same across near miss, minor, and major injury. CONCLUSIONS: Finding from this study support the use of near miss and minor injury data as potential outcome measures for injury prevention programs.

Effects of methylphenidate on subtypes of attention-deficit/hyperactivity disorder.

OBJECTIVE: To compare the effects of methylphenidate on attention-deficit/hyperactivity disorder (ADHD) subtypes. METHOD: Nineteen ADHD/inattentive (ADHD/I) and 22 ADHD/combined (ADHD/C) 6- to 12-year-old children entered a 6-week, double-blind trial of placebo and methylphenidate in divided doses (0.94 +/- 0.02 mg/kg/day = 33.06 +/- 1.40 mg/day). ADHD children received a restricted arithmetic task without medication before the trial and after their noon dose on the last day of each phase. Thirty-four unmedicated controls were tested at comparable time points. Parents and teachers rated ADHD children before and after each phase of the trial; parents rated controls before the study. RESULTS: Controls had marginally better arithmetic performance than children with ADHD/C who outperformed ADHD/I children. Unmedicated children with ADHD exceeded controls in task-incompatible behaviors during restricted arithmetic. Under methylphenidate, both ADHD subtypes reached control levels of arithmetic performance and task-incompatible behavior. Before the trial, parents rated children with both ADHD subtypes higher than controls on inattention, hyperactivity, and oppositionality/aggression and parents and teachers rated ADHD/C children higher than ADHD/I children on hyperactivity and oppositionality/aggression but not inattention. Methylphenidate lowered parent and teacher ratings of inattention and hyperactivity for those with both ADHD subtypes, but ratings of children with ADHD/C decreased more in hyperactivity and aggression. CONCLUSIONS: Methylphenidate ameliorated task-incompatible behavior, arithmetic performance, and inattention comparably in both ADHD subtypes, whereas medication reduced hyperactivity and aggression largely in children with ADHD/C.