An estimation of the endoscopist's musculoskeletal injury risk for right and left lateral decubitus positions during colonoscopy: a field-based ergonomic study.

BACKGROUND: Colonoscopy exposes endoscopists to awkward postures and prolonged forces, which increases their risk of musculoskeletal injury. Patient positioning has a significant impact on the ergonomics of colonoscopy. Recent trials have found the right lateral decubitus position is associated with quicker insertion, higher adenoma detection rates, and greater patient comfort compared to the left lateral decubitus position. However, this patient position is perceived as more strenuous by endoscopists. METHODS: Nineteen endoscopists were observed performing colonoscopies during a series of four-hour endoscopy clinics. Durations of each patient position (right lateral decubitus, left lateral decubitus, prone, and supine) were recorded for all observed procedures (n = 64). Endoscopist injury risk was estimated by a trained researcher for the first and last colonoscopies of the shifts (n = 34) using Rapid Upper Limb Assessment (RULA), an observational ergonomic tool that estimates risk of musculoskeletal injury by scoring postures of the upper body and factors such as muscle use, force, and load. The total RULA scores were compared with a Wilcoxon Signed-Rank test for patient position (right and left lateral decubitus) and time (first and last procedures) with significance taken at p < 0.05. Endoscopist preferences were also surveyed. RESULTS: The right lateral decubitus position was associated with significantly higher RULA scores than the left lateral decubitus position (median 5 vs. 3, p < 0.001). RULA scores were not significantly different between the first and last procedures of the shifts (median 5 vs. 5, p = 0.816). 89% of endoscopists preferred the left lateral decubitus position, primarily due to superior ergonomics and comfort. CONCLUSION: RULA scores indicate an increased risk of musculoskeletal injury in both patient positions, with greater risk in the right lateral decubitus position.

Acceptability of an online relational intimacy and sexual enhancement (iRISE) intervention after breast cancer.

The purpose of this study was to develop and evaluate an online relational intimacy and sexual enhancement (iRISE) intervention for couples experiencing sexual difficulties following breast cancer (BC). The acceptability of iRISE was evaluated using a single-arm, qualitative design, with 14 couples completing satisfaction surveys and posttreatment interviews. The intervention was found to be acceptable, as demonstrated by high satisfaction ratings and qualitative feedback regarding iRISE and its online delivery. Couples spoke about the helpfulness of iRISE and how the intervention improved their sexual relationship. The use of video conferencing (eTherapy) was widely accepted by participants, who highlighted several advantages of this modality. Overall, the results support the acceptability of this online psychosexual intervention for couples affected by BC. The empirical and theoretical basis for the design of iRISE along with findings from a qualitative analysis of couples' experiences of the intervention's helpfulness to them is discussed.

Reliability and Validity of Commercially Available Wearable Devices for Measuring Steps, Energy Expenditure, and Heart Rate: Systematic Review.

BACKGROUND: Consumer-wearable activity trackers are small electronic devices that record fitness and health-related measures. OBJECTIVE: The purpose of this systematic review was to examine the validity and reliability of commercial wearables in measuring step count, heart rate, and energy expenditure. METHODS: We identified devices to be included in the review. Database searches were conducted in PubMed, Embase, and SPORTDiscus, and only articles published in the English language up to May 2019 were considered. Studies were excluded if they did not identify the device used and if they did not examine the validity or reliability of the device. Studies involving the general population and all special populations were included. We operationalized validity as criterion validity (as compared with other measures) and construct validity (degree to which the device is measuring what it claims). Reliability measures focused on intradevice and interdevice reliability. RESULTS: We included 158 publications examining nine different commercial wearable device brands. Fitbit was by far the most studied brand. In laboratory-based settings, Fitbit, Apple Watch, and Samsung appeared to measure steps accurately. Heart rate measurement was more variable, with Apple Watch and Garmin being the most accurate and Fitbit tending toward underestimation. For energy expenditure, no brand was accurate. We also examined validity between devices within a specific brand. CONCLUSIONS: Commercial wearable devices are accurate for measuring steps and heart rate in laboratory-based settings, but this varies by the manufacturer and device type. Devices are constantly being upgraded and redesigned to new models, suggesting the need for more current reviews and research.

A survey of risk factors for digit injuries among dogs training and competing in agility events.

OBJECTIVE To identify potential risk factors for digit injuries in dogs training and competing in agility events. DESIGN Internet-based, retrospective, cross-sectional survey. ANIMALS 1,081 dogs training or competing in agility events. PROCEDURES Data were collected for eligible animals via retrospective surveys distributed electronically to handlers of dogs participating in agility-related activities. Variables evaluated included demographic (handlers) and signalment (dogs) information, physical characteristics of dogs, and injury characteristics. A separate survey of dogs competing in similar agility-related activities but without digit injuries was also administered. Multivariable logistic regression was used to develop a model for assessment of risk factors. RESULTS Data were collected from 207 agility dogs with digit injuries and 874 agility dogs without digit injuries. Factors associated with significantly increased odds of injury included Border Collie breed (OR, 2.3; 95% confidence interval [CI], 1.5 to 3.3), long nails (OR, 2.4; 95% CI, 1.3 to 4.5), absence of front dewclaws (OR, 1.9; 95% CI, 1.3 to 2.6), and greater weight-to-height ratio (OR, 1.5; 95% CI, 1.1 to 2.0). Odds of injury decreased with increasing age of the dog (OR, 0.8; 95% CI, 0.76 to 0.86). CONCLUSIONS AND CLINICAL RELEVANCE Results should be cautiously interpreted because of potential respondent and recall bias and lack of review of medical records. Nevertheless, results suggested that retaining healthy dewclaws, maintaining lean body mass, and trimming nails short for training and competition may decrease the likelihood of digit injuries. Research to investigate training practices, obstacle construction specifcations, and surface considerations for dogs competing in agility activities is indicated.

The magnitude of muscular activation of four canine forelimb muscles in dogs performing two agility-specific tasks.

BACKGROUND: The purpose of this study was to measure the muscular activation in four forelimb muscles while dogs performed agility tasks (i.e., jumping and A-frame) and to provide insight into potential relationships between level of muscular activation and risk of injury. Muscle activation in eight healthy, client-owned agility dogs was measured using ultrasound-guided fine-wire electromyography of four specific forelimb muscles: Biceps Brachii, Supraspinatus, Infraspinatus, and Triceps Brachii - Long Head, while dogs performed a two jump sequence and while dogs ascended and descended an A-frame obstacle at two different competition heights. RESULTS: The peak muscle activations during these agility tasks were between 1.7 and 10.6 fold greater than walking. Jumping required higher levels of muscle activation compared to ascending and descending an A-frame, for all muscles of interest. There was no significant difference in muscle activation between the two A-frame heights. CONCLUSIONS: Compared to walking, all of the muscles were activated at high levels during the agility tasks and our findings indicate that jumping is an especially demanding activity for dogs in agility. This information is broadly relevant to understanding the pathophysiology of forelimb injuries related to canine athletic activity.

A systematic review of interventions to promote work participation in older workers.

PURPOSE: The objective of this systematic review was to synthesize evidence on the effectiveness of interventions aimed at promoting work participation in older workers. METHODS: We followed a systematic review process developed by the Institute for Work & Health and a best evidence synthesis that ranked evidence as strong, moderate, limited, or insufficient. RESULTS: Seven electronic databases were searched from inception to March 2014. Evidence from 14 studies were synthesized in 4 different intervention categories: multi-component, exercise, medication and other interventions. There was moderate evidence that work participation was improved by multi-component interventions encompassing at least two of three components (health service delivery, coordination of services, and work modifications). There was not enough evidence to recommend the other interventions. CONCLUSIONS: Although there is a vast body of research on work participation of older workers, there are only a few high quality intervention studies aimed at improving work participation in this population. We recommend that multi-component interventions could be considered for implementation by practitioners to help improve work participation in older workers. PRACTICAL APPLICATIONS: With a moderate level of evidence, multi-component interventions could be considered for use in practice if practitioners deem it suitable for their setting. There is not enough evidence to recommend exercise interventions, pharmaceutical interventions, different types of surgeries, patient education or work accommodation alone to improve work participation. However, the lack of evidence should not be considered, as absence of effect and practitioners should continue to be creative in developing solutions.

Sexual identity after breast cancer: sexuality, body image, and relationship repercussions.

PURPOSE OF REVIEW: Breast cancer treatment indelibly alters a woman's reproductive and sexual functioning, body integrity, and the ways in which she self-identifies as a sexual being. Improved understanding of how treatment affects these aspects of a woman's health, identity, and relationships is necessary to ameliorate the effectiveness with which these issues are addressed by healthcare providers. RECENT FINDINGS: Women with breast cancer experience significantly greater rates of sexual dysfunction and poorer body image than do healthy women. Despite this reality, most breast cancer patients are dissatisfied with the amount and quality of care they receive from their healthcare providers around sexuality. Although a substantial proportion of women endorse difficulties with sexual functioning, reproduction, and body image, each woman's experience is individual and contextual, influenced by a range of factors (e.g., age, illness stage, treatment type(s), relationship status, and others). SUMMARY: A high proportion of women experience difficulties with sexual health and self-concept secondary to breast cancer, yet an overwhelming number report receiving inadequate or nonexistent care in these domains from their healthcare providers. There remains too wide a gap between the needs of this population and the healthcare system's response to such needs. To bridge this gap, oncology professionals across a range of disciplines must be better trained to identify, assess, and treat such difficulties, preferably using a multimodal approach that includes biological, as well as psychological and social, strategies.

Internet-based survey of the nature and perceived causes of injury to dogs participating in agility training and competition events.

OBJECTIVE: To characterize injuries (on the basis of type and severity of injury and affected region of the body) among dogs participating in agility training and competition events and examine associations between injury characteristics and perceived causes of injury. DESIGN: Internet-based, retrospective, cross-sectional survey. ANIMALS: 3,801 privately owned dogs participating in agility training or trials. PROCEDURES: A retrospective electronic survey was developed to investigate demographic factors for dogs and handlers, frequency of participation in agility training and competition, and perceived causes and characteristics of injuries acquired by dogs during agility-related activities. Respondents were handlers recruited through member lists of large canine agility associations in Canada and the United Kingdom and through promotion on an agility blog site. Associations between cause and anatomic site or type of injury and between injury severity (mild vs severe) and setting (competition vs practice) were investigated. RESULTS: Surveys were received from 1,669 handlers of 3,801 agility dogs internationally. Handler-reported data indicated 1,209 of 3,801 (32%) dogs had ≥ 1 injury; of 1,523 analyzed injuries, the shoulder (349 injuries), back (282), and neck (189) regions and phalanges (202) were predominantly affected. Soft tissue injuries (eg, strain [muscle or tendon injury; 807], sprain [ligament injury; 312], and contusion [200]) were common. Injuries were most commonly incurred during interactions with bar jumps, A-frames, and dog walk obstacles (260, 235, and 177 of 1,602 injuries, respectively). Anatomic site and type of injury were significantly associated with perceived cause of injury. CONCLUSIONS AND CLINICAL RELEVANCE: These findings provided a basis for further experimental studies to identify specific mechanisms of various types of injury in dogs that participate in agility activities.

Survey-based analysis of risk factors for injury among dogs participating in agility training and competition events.

OBJECTIVE: To identify potential risk factors for agility-related injuries among dogs. DESIGN: Internet-based, retrospective, cross-sectional survey. ANIMALS: 3,801 privately owned dogs participating in agility training or trials. PROCEDURES: A retrospective electronic survey was used to investigate potential risk factors for injury among dogs participating in agility-related activities. Respondents were handlers recruited through member lists of large canine agility associations in Canada and the United Kingdom and through promotion on an agility blog site. Variables evaluated included demographic information for handlers and dogs, exposure variables (eg, frequency of agility practice and competition in the past year), and use of preventive measures intended to keep dogs fit for agility (warmup, cooldown, or conditioning exercises; alternative therapeutic treatments [eg, acupuncture, massage, or chiropractic care]; or dietary supplement products). RESULTS: Data were collected from 1,669 handlers of 3,801 agility dogs internationally; 1,209 (32%) dogs incurred ≥ 1 injury. Previous injury (OR, 100.5), ≤ 4 years of agility experience for dogs (OR, 1.5), use of alternative therapeutic treatments (OR, 1.5), and Border Collie breed (OR, 1.7) were associated with increased odds of injury. Handlers having 5 to 10 or > 10 years of experience (OR, 0.8 and 0.6, respectively) and dogs having > 4 years of experience in the sport (OR, 0.6) were associated with decreased odds of injury. CONCLUSIONS AND CLINICAL RELEVANCE: Specific factors were associated with agility-related injuries in dogs. Educational prevention strategies should target at-risk populations in an effort to reduce potential injuries. Future research should focus on the biomechanical factors associated with agility-related injuries.

Toward clinical care guidelines for supporting rehabilitative vaginal dilator use with women recovering from cervical cancer.

PURPOSE: Building upon the findings of a recent qualitative investigation of women's experiences with rehabilitative vaginal dilator use, the primary goal of this article is to outline a set of preliminary clinical care recommendations that health care professionals may draw upon in addressing women's unique experiences with vaginal dilator use including their multifaceted struggles with the procedure, possibly enhancing adherence to this practice. METHODS: Ten women participated in in-depth interviews regarding their experiences with using the dilator as prescribed by their health care providers. Following the analysis of these interviews, members of the interdisciplinary research team met to review and discuss the development of clinical care recommendations stemming from these findings. RESULTS: Eight care recommendations aimed at addressing the concerns expressed by the women interviewed and at improving women's overall experiences with rehabilitative dilator use emerged: (1) introduce the dilator in a light and straightforward manner; (2) enhance dilator accessibility; (3) introduce the vaginal dilator early on in treatment; (4) emphasize health maintenance over intercourse as a benefit of dilator use; (5) explore and acknowledge women's values and views of sexuality; (6) increase awareness and sensitivity to emotional reactions; (7) enhance psychoeducational resources for supporting vaginal dilator use; and (8) ensure consistent institutional practice when introducing the dilator. CONCLUSION: The clinical care recommendations proposed here reflect the various challenges women may encounter when using the vaginal dilator--which vary from practical to, for some, profoundly emotional--and are designed to better position health care providers to help women navigate these challenges.

From "sex toy" to intrusive imposition: a qualitative examination of women's experiences with vaginal dilator use following treatment for gynecological cancer.

INTRODUCTION: Regular use of vaginal dilators has been recommended as a prophylactic measure following radiation treatment for gynecological cancers in order to minimize vaginal stenosis and promote optimal healing of the vagina. Despite the well-established reluctance of women to adopt this practice, little is known about the difficulties and concerns associated with vaginal dilator use. AIM: To investigate women's experiences with the vaginal dilator and to understand the psychosocial factors that influence women's adoption of rehabilitative dilator use. METHODS: This is an exploratory qualitative study using semi-structured interviews with a sample of 10 women with a history of gynecological cancer and who were prescribed a vaginal dilator. Interviews were analyzed using the grounded theory method and examined for recurrent themes. MAIN OUTCOME MEASURE: The main outcome measure was a semi-structured interview comprised of open-ended questions designed to elicit information concerning topic areas relevant to gynecological cancer, vaginal dilator use, and sexuality. RESULTS: The analysis resulted in five main categories underlying the core category of "From 'sex toy' to intrusive imposition." These were: (i) embarrassing sex toy; (ii) reliving the invasion of treatment; (iii) aversive "hands-on" experience; (iv) not at the forefront of my recovery; and (v) minimizing the resistance. CONCLUSIONS: Rehabilitative vaginal dilator use is a complex, multifaceted, and personal phenomenon that carries deep psychological and emotional implications that make it intrusive. These findings may enhance the way in which vaginal dilators are introduced and help healthcare providers address better women's difficulties and concerns with the dilators. Ultimately, it may also lead to improved health maintenance and quality of life for women recovering from gynecological cancer.

Systematic review of intervention practices for depression in the workplace.

DESIGN: Systematic Review. OBJECTIVE: To determine which intervention approaches to manage depression in the workplace have been successful and yielded value for employers in developed economies. DATA SOURCES: We searched MEDLINE, EMBASE, CINAHL, Central, PsycINFO, and Business Source Premier up to June 2010 using search terms in four broad areas: work setting, depression, intervention, and work outcomes. STUDY SELECTION: Two independent reviewers selected potential articles that met the following criteria: working age individuals with mild or moderate depression; interventions or programs that were workplace-based or could be implemented and/or facilitated by the employer; inclusion of a comparator group in the analysis; outcomes of prevention, management, and recurrences of work disability or sickness absence, and work functioning. METHODS: Two reviewers independently reviewed each article for quality and extracted data using standardised forms. Following guidelines from the GRADE Working Group, the quality of evidence addressing each outcome was graded as high, moderate, low, or very low on the basis of six criteria: study design, risk of bias, consistency, generalisability, data precision, and economic benefit. Using this information and following Cochrane Collaboration guidelines, the findings for each intervention were summarised and key messages were developed. RESULTS: We identified ten randomised trials and two non-randomised studies from various countries and jurisdictions that evaluated a wide range of intervention practices. The evidence was graded as "very low" for all outcomes identified. Therefore, no intervention could be recommended. CONCLUSIONS: To date, there is insufficient quality of evidence to determine which interventions are effective and yield value to manage depression in the workplace.

A systematic review of the effectiveness of occupational health and safety training.

OBJECTIVES: Training is regarded as an important component of occupational health and safety (OHS) programs. This paper primarily addresses whether OHS training has a beneficial effect on workers. The paper also examines whether higher engagement OHS training has a greater effect than lower engagement training. METHODS: Ten bibliographic databases were searched for pre-post randomized trial studies published in journals between 1996 and November 2007. Training interventions were included if they were delivered to workers and were concerned with primary prevention of occupational illness or injury. The methodological quality of each relevant study was assessed and data was extracted. The impacts of OHS training in each study were summarized by calculating the standardized mean differences. The strength of the evidence on training's effectiveness was assessed for (i) knowledge, (ii) attitudes and beliefs, (iIi) behaviors, and (iv) health using the US Centers for Disease Control and Prevention's Guide to Community Preventive Services, a qualitative evidence synthesis method. RESULTS: Twenty-two studies met the relevance criteria of the review. They involved a variety of study populations, occupational hazards, and types of training. Strong evidence was found for the effectiveness of training on worker OHS behaviors, but insufficient evidence was found of its effectiveness on health (ie, symptoms, injuries, illnesses). CONCLUSIONS: The review team recommends that workplaces continue to deliver OHS training to employees because training positively affects worker practices. However, large impacts of training on health cannot be expected, based on research evidence.

Minimal change is sensitive, less specific to recovery: a diagnostic testing approach to interpretability.

OBJECTIVE: The pursuit of interpretability of longitudinal measures of patient outcome has led to several methods for defining minimal amounts of change or final states that are important. Little is known about the best method. The purpose of this study was to directly compare methods using diagnostic utility to evaluate their usefulness. STUDY DESIGN AND SETTING: Secondary analysis of longitudinal cohort data of persons attending physiotherapy for shoulder pain. Disability of the arm, shoulder, and hand outcome fielded at baseline and 3 months. Published methods were used to define positive response in scores: minimal change, final state, and combined change and final state. Proportions described as improved were compared (Kappa) and diagnostic testing techniques used to evaluate the strengths of each. RESULTS: Only moderate agreement was found between methods (Kappa=0.47). Minimal clinically important differences were most sensitive but not specific. Final states were less sensitive, more specific, and most accurate. Combinations were slightly less specific. CONCLUSION: A new approach allowed us to evaluate the relative merits and risks of different approaches to interpreting longitudinal patient outcomes. Our study points to a combination of change greater than error and/or a final score within general population norms as being the most clinically sensible with strong diagnostic accuracy.

Effectiveness of participatory ergonomic interventions on health outcomes: a systematic review.

The objective of this study was to conduct a systematic review of the literature on the effectiveness of participatory ergonomic (PE) interventions for improving workers' health. The search strategy targeted six electronic databases and identified 442 potential articles. Each article was examined by pairs of reviewers for relevance (assessed a participative ergonomic workplace intervention, with at least one health outcome, published in English in peer reviewed literature). Twenty-three articles met relevance criteria and were then appraised for methodological strength. Using a best evidence synthesis approach, 12 studies that were rated as 'medium' or higher provided partial to moderate evidence that PE interventions have a positive impact on: musculoskeletal symptoms, reducing injuries and workers' compensation claims, and a reduction in lost days from work or sickness absence. However, the magnitude of the effect requires more precise definition.

Workplace-based return-to-work interventions: a systematic review of the quantitative literature.

INTRODUCTION: A systematic review was conducted to review the effectiveness of workplace-based return-to-work (RTW) interventions. METHOD: Seven databases were searched, in English and French, between January 1990 and December 2003 for peer-reviewed studies of RTW interventions provided at the workplace to workers with work disability associated with musculoskeletal or other pain-related conditions. Methodological quality appraisal and data extraction were conducted by pairs of reviewers. RESULTS: Of a total of 4124 papers identified by the search, 10 studies were of sufficient quality to be included in the review. There was strong evidence that work disability duration is significantly reduced by work accommodation offers and contact between healthcare provider and workplace; and moderate evidence that it is reduced by interventions which include early contact with worker by workplace, ergonomic work site visits, and presence of a RTW coordinator. For these five intervention components, there was moderate evidence that they reduce costs associated with work disability duration. Evidence for sustainability of these effects was insufficient or limited. Evidence regarding the impact of supernumerary replacements was insufficient. Evidence levels regarding the impact of the intervention components on quality-of-life was insufficient or mixed. CONCLUSIONS: Our systematic review provides the evidence base supporting that workplace-based RTW interventions can reduce work disability duration and associated costs, however the evidence regarding their impact on quality-of-life outcomes was much weaker.

Workplace organizational policies and practices in Ontario educational facilities.

BACKGROUND: Workplace organizational policies and practices (OPPs) play a pivotal role in managing injury and disability. This study identifies the workplace OPPs in Ontario's education sector. METHODS: OPPs were examined using a cross-sectional survey with 157 participants. The relationship among the type of school, workplace OPPs and injury and disability outcomes were investigated. RESULTS: Mean subscale scores (potential range 1-5) varied from 3.1 (SD, 1.0) to 4.2 (SD, 0.6) for all schools. Private schools scored lowest on measures of disability prevention, disability management, and corporate culture. Ergonomic practices and return to work initiatives were achieved less frequently than other OPPs for all schools. Higher scores on safety diligence were associated with lower injury and disability incidence (proportion of variance explained ranged from 10 to 23%). Higher scores on people-oriented culture were associated with lower disability incidence and duration (proportion of variance explained ranged from 7 to 20%). CONCLUSIONS: Public schools engage more often in workplace OPPs than private schools. Improved achievements on safety diligence and people-oriented culture practices predict reduced injury and disability outcomes.