Gestión de la consulta de otorrinolaringología durante el estado de alarma por la pandemia del COVID-19. Es útil la consulta telefónica en ORL? / Management of the ENT consultation during the COVID-19 pandemic alert. Are ENT telephone consultations useful?

OBJETIVO: Describir cómo se gestionaron las consultas de los servicios de Otorrinolaringología y Cirugía de Cabeza y Cuello (ORLCCC) del Hospital Morales Meseguer (HMM) de Murcia y del Hospital Virgen del Castillo (HVC) de Yecla durante el periodo de estado de alarma debido a la COVID-19 y analizar los resultados obtenidos para valorar la utilidad de la consulta telefónica en nuestra especialidad. MATERIAL Y MÉTODOS: Desde el día 16 de marzo en los servicios de ORLCCC de los hospitales HMM y HVC comenzamos a realizar la consulta de forma telefónica. Debido a la disparidad de actuación de los diferentes miembros de los servicios se decidió realizar un protocolo para la gestión de dichas consultas que se comenzó a aplicar el 23 de marzo. RESULTADOS: Durante el periodo de estudio en las consultas de ambos servicios se atendieron 1.054 pacientes, de los cuales 663 (62,9%) fueron primeras visitas y 391 (37,10%) fueron visitas sucesivas. El 21,73% (229) de las consultas se pudieron resolver de forma telefónica, el 10,82% (114) precisaron atención de forma presencial, al 57,40% (605) se les indicó revisión a demanda según la evolución de su patología y el 10,05% (106) de los pacientes no se pudieron localizar de forma telefónica. DISCUSIÓN: La situación de estado de alarma ocasionada por la COVID-19 ha supuesto un condicionante en el desempeño de nuestra labor asistencial. En los servicios ORLCCC de los hospitales HMM y HVC decidimos realizar la consulta de forma telefónica como alternativa a la consulta tradicional. Durante este periodo hemos observado que hasta el 21,73% de las consultas se pudieron solventar de forma telefónica. CONCLUSIÓN: La consulta telefónica parece una herramienta muy útil para atender a nuestros pacientes evitando el riesgo de contagio por COVID-19 durante el estado de alarma. Además, según los datos analizados y los diferentes estudios, parece una buena alternativa a la consulta tradicional en pacientes seleccionados

OBJECTIVE: To describe how the ENT and Head and Neck departments of the HMM and HVC hospitals were managed during the COVID-19 state of alert and to analyse the results obtained to assess the usefulness of telephone consultations in our specialty. MATERIAL AND METHODS: From March 16, the ENT and Head and Neck departments of the HMM and HVC Hospitals began telephone consultations. Due to the disparity in the actions of the different department members, the decision was made to create a protocol to manage these consultations which started to be implemented March 23. RESULTS: During the study period, 1054 patients were attended in the consultations of both departments; 663 (62.9%) were first visits and 391 (37.10%) were successive visits. Twenty-one percent (229) of the consultations could be resolved by telephone, 10.82% (114) required face-to-face care, 57.40% (605) were indicated for an on-demand check-up depending on their disease course, and 10.05% (106) of the patients could not be reached by telephone. DISCUSSION: The state of alarm caused by COVID-19 has been a determining factor in how we undertake our care work. In the ENT and Head and Neck departments of the HMM and HVC Hospitals we decided to carry out consultations by telephone as an alternative to the traditional consultation. During this period, we have observed that up to 21.73% of the consultations could be dealt with by telephone. CONCLUSION: The telephone consultation seems to be a very useful tool to attend our patients avoiding the risk of COVID-19 infection during the state of alarm. Furthermore, according to the data analysed and the different studies, it seems a good alternative to the traditional consultation in selected patients

Normative hand grip strength and prediction models for Iranian office employees.

BACKGROUND: Normative data on Hand grip strength has a wide range of application and is of great value. OBJECTIVE: To establish gender and age-specific reference data concerning hand grip strength of Iranian office workers, to explore possible relationships with demographic and anthropometric factors and to develop appropriate predictive models. METHODS: The study population included 418 (220 males and 198 females) Iranian office employees. They were divided into 5-year age-groups. Hand length, palm width, palm length, forearm length, wrist circumference, and forearm circumference were measured by means of a digital Caliper (±0.01 mm) and a tape meter (±0.1 cm). The value of hand grip strength was measured by JAMAR hydraulic dynamometer respecting the American Society of Hand Therapy recommendations. RESULTS: The average of grip strength for dominant and non-dominant hands (in Kg) respectively was 51.10±9.50 and 46.90±9.89 for male and 28.76±4.47 and 25.89±4.60 for female. Age was curvilinearly related to hand grip strength. All selected hand dimensions were highly correlated with grip strength; palm width, palm length and hand length being the most correlated ones, respectively. Prediction equations of hand grip strength were developed for dominant and non-dominant hands of both genders. CONCLUSIONS: Suggested norms would provide more accuracy for ergonomic designers as well as health practitioners especially with regards to proposed prediction models with which grip strength could be estimated faster and easier.

Prevalence rate of neck, shoulder and lower back pain in association with age, body mass index and gender among Malaysian office workers.

BACKGROUND: Malaysian office workers often experience Musculoskeletal Discomfort (MSD) which is typically related to the low back, shoulders, and neck. OBJECTIVES: The objective of this study was to examine the occurrence of lower back, shoulder, and neck pain among Malaysian office workers. METHODS: 752 subjects (478 women and 274 men) were randomly selected from the Malaysian office workers population of 10,000 individuals. The participants were aged between 20-50 years and had at least one year of work experience. All participants completed the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ). Instructions to complete the questinnaire were given to the participants under the researchers supervision in the morning before they started a day of work. The participants were then classified into four categories based on body mas index (BMI) (BMI:≤18.4, 18.5-24.99, 25-29.99, ≥30) and age (Age: 20-29, 30-39, 40-49, ≥50). RESULTS: There was a significant association between pain severity in gender and right (p = 0.046) and left (p = 0.041) sides of the shoulders. There was also a significant association between BMI and severity of pain in the lower back area (p = 0.047). It was revealed that total pain score in the shoulders was significantly associated with age (p = 0.041). CONCLUSIONS: The results of this study demonstrated that a significant correlation existed between pain servity for gender in both right and left shoulder. These findings require further scientific investigation as do the identification of effective preventative stratgies.

The application of a feasible exercise training program in the office setting.

BACKGROUND: Previous research support the claim that people who work in offices and sit for a long time are particularly prone to musculoskeletal disorders. OBJECTIVE: The main objective of this paper is to introduce an exercise training program designed to decrease muscle stiffness and pain that can be performed in the office setting. METHODS: Forty healthy office workers (age: 28±5.3 years old; body mass: 87.2±10.2 kg; height: 1.79±0.15 m) apart from suffering from any sub-clinical symptoms of muscle and joint stiffness, and who had at least two years of experience in office work were chosen and randomly assigned to either an experimental group (n = 20) or a control group (n = 20). The experimental group performed the exercise training program three times a week for 11 weeks. The Cornell Musculoskeletal Discomfort Questionnaire was used to measure the pain levels in the neck, shoulders, and lower back areas. The Borg CR-10 Scale was used to measure their perceived exertion when doing the exercises, and a goniometer was used to measure the changes in range of motion (ROM) of the neck, hips, knees, and shoulders. RESULTS: The overall results indicated that the exercise program could significantly (p < 0.05) reduce the neck, shoulders, and lower back pains of the participants in the exercise group while those in the control group showed no improvement in those pains. There were significant (p < 0.05) increases in the ROM of the hips, the neck, both knees and shoulders in the exercise group. Participants showed significant (p = 0.011) decreases in perceived exertion scores after the exercises. CONCLUSIONS: The exercise training program designed in this study not only can effectively reduce neck, shoulders, and lower back pains, but also can improve the ROM or flexibility of the office workers.

[Risk assessment of work-related stress: the case of a public administration]. / Valutazione del rischio stress lavoro correlato: il caso di una pubblica amministrazione.

The paper describes a case study of work related stress assessment in a public administration, based on an objective methodology (Romano, 2009). The Ispes1 forms (2010) have been used to perform the assessment. They have been filled during some focus group in which 45 workers have been involved, divided into 7 homogeneous groups relying on their department, back-office vs front-office typology of work and the office collocation. According to the Grounded Theory perspective, through the content analysis three further risk factors arose, comparing to the Ispesl forms, such as: (a) the quality of communication, (b) the relationship among and with leaders and colleagues, (c) the presence of discriminatory behaviours. Hence, on the basis of the results, mostly for a deeper analysis of work related stress assessment in a public administration, we suggest to consider these further risk factors.

[Regional classification of office specialists' partial labour market for use in vocational rehabilitation]. / Regionalklassifikation für den beruflichen Teilarbeitsmarkt der Bürofachkräfte zur Anwendung in der beruflichen Rehabilitation.

The core objective of all those involved in vocational rehabilitation is integration into the primary labour market. In order to achieve this effectively and efficiently the disparities of regional and occupational partial labour markets have to be transparent. On the example of vocational retraining centres for adults with disabilities (Berufsförderungswerke) and of office specialists' partial labour market this paper selects relevant labour market indicators, calculates an empirical regional classification using relative niveau data and describes implications. Data base are statistics of the Federal Employment Agency for office specialists (profession ID 781). Cluster analytic results are 6 stable and valid regional clusters.

[Complex analysis of risk factors of hypertension in subjects involved in managerial activity].

We performed complex analysis of genetic and nongenetic factors facilitating development of arterial hypertension in subjects involved in managerial activity and revealed peculiarities of dermatoglyphic phenotype of susceptibility to this type of pathology. By means of methods of pattern recognition we assessed power and character of effect of each of investigated risk factors. Using mathematical model we elaborated prognosis of efficacy of various preventive procedures. Basing on results of this study we created system of criteria for formation of a group of elevated risk of hypertension and system of measures aimed at prevention of cardiovascular diseases in subjects involved in neuro-emotional labor.

[Study of the derivations to an external consultation of Internal Medicine: can be managed the waiting list?]. / Estudio de las derivaciones a una consulta externa de Medicina Interna: se puede gestionar la lista de espera?

BACKGROUND: The lack of coordination and organization between primary and specialized attention, generates inefficiency bags in the area of external consultations. MATERIAL AND METHOD: The characteristics of the attention of 120 patients derived consecutively to an external Internal Medicine consultation of a local hospital are analyzed. RESULTS: Of the 120 mentioned patients 19 did not appear (16.23%). 70.3% of the taken care of patients came from primary attention and 29.7% did it of specialized attention. Of the patients derived by primary attention: 63.3% went without data adapted in the derivation leaf, 59.2% did not contribute complementary diagnostic tests and 40.8% were registered in the first consultation. Of the patients derived from specialized attention: 100% contribute clinical information to the consultation, 90% contribute complementary studies and 56.65% are registered in the first consultation. CONCLUSIONS: The discontinuity in the attention between primary and specialized attention generates an inefficient use of the resources, that in the area of external consultations influences in the appearance of waiting lists.

Low back pain and lumbago-sciatica in nurses and a reference group of clerks: results of a comparative prevalence study in Germany.

OBJECTIVES: To gain more conclusive evidence on the question of work-related low-back disorders in German nurses, a comprehensive study with several methodological approaches was performed. METHODS: As part of this project, a cross-sectional study on working conditions and prevalence of low back pain, a sample of 3,332 nurses and 1,720 clerks as reference group was investigated by a questionnaire. In this article, final results referring to a sub-sample of 2,207 nurses and 1,177 clerks who had always worked in their profession, so that we could exclude confounding effects of former occupations, will be presented. Excluding the confounding effects of several covariates by logistic regression, we computed relative risks for different pain symptoms. RESULTS: The data suggest a considerably higher risk of low back pain for nurses than for the reference population of clerks. Results, however, differ markedly when specific pain symptoms are considered. With respect to lumbago-sciatica and sciatica - which have to be regarded as indicators for possible disc herniation - the study group's relative risk is the most elevated (2.88 for point prevalence of lumbago-sciatica/sciatica). Adjusting the results for several confounders and covariates leads to still higher estimations of nurses' relative risk.

Physical and psychosocial prerequisites of functioning in relation to work ability and general subjective well-being among office workers.

OBJECTIVES: The purpose of the study was to investigate the physical and psychological prerequisites of functioning, as well as the social environment at work and personal factors, in relation to work ability and general subjective well-being in a group of office workers. METHODS: The study was a descriptive cross-sectional investigation, using path analysis, of office workers. The subjects comprised 88 volunteers, 24 men and 64 women, from the same workplace [mean age 45.7 (SD 8.6) years]. The independent variables were measured using psychosocial and physical questionnaires and physical measurements. The first dependent variable, work ability, was measured by a work ability index. The second dependent variable, general subjective well-being, was assessed by life satisfaction and meaning of life. The variables were structured according to a modified version of the International Classification of Functioning, Disability and Health. RESULTS: Forward flexion of the spine, intensity of musculoskeletal symptoms, self-confidence, and mental stress at work explained 58% of work ability and had indirect effects on general subjective well-being. Self-confidence, mood, and work ability had a direct effect on general subjective well-being. The model developed explained 68% of general subjective well-being. Age played a significant role in this study population. CONCLUSIONS: The prerequisites of physical functioning are important in maintaining work ability, particularly among aging workers, and psychological prerequisites of functioning are of even greater importance in maintaining general subjective well-being.

Outside financial interests in radiology offices: prevalence, payment, and practice patterns in involved offices.

OBJECTIVE: The purposes of our study were to (1) investigate the prevalence of different patterns of outside financial interests in radiology offices and of different methods of compensating these interests and (2) determine how the professional, operational, and practice characteristics of the offices vary with the patterns of outside interest. The term "office" means nonhospital practice sites, including those called imaging centers or clinics; "outside interests" refers to parties other than physicians in the group of physicians who serve the office. MATERIALS AND METHODS: Data are for 516 office sites served by radiology groups. Data were collected as part of a national, stratified random sample survey of radiology groups in the United States done by the American College of Radiology in 1992. Responses were weighted to make the results representative of all radiology groups in the United States with offices. RESULTS: Parties other than the physicians in the practice serving an office had a financial interest in 41% of offices. In about half of these (20% of all offices), physicians in the practice had no financial interest at all. The most common categories of outside financial interest were referring physicians (21%), hospitals (19%), and non-physician entrepreneurs (12%); some offices reported more than one type of outside financial interest. All categories were more common in high-tech offices (offices that offered CT, MR imaging, or nuclear medicine studies) than in non-high-tech offices. Overall, 50% of high-tech offices and 35% of non-high-tech offices had outside financial interests. The most common method of compensating outsiders was giving them shares or dividends or a percentage of the profits. The average number of procedures per full-time-equivalent radiologist was higher in offices in which only outsiders (and not the group serving the office) had a financial interest than in other offices, and fewer of the former offices offered mammography. Offices with no outside interests were more likely than those with any outsiders to regularly do chest, spinal, gastrointestinal, and urologic procedures. CONCLUSIONS: Outside financial interests, and the problems of cost and access they may engender, are fairly common in radiology offices. Nationally, joint ventures including referring physicians, which are now under legal attack, number more than 500. Differences in who owns radiology offices were associated with statistically significant variations among offices in workload, staffing, and types of procedures done.