The effect of forearm support on musculoskeletal discomfort during call centre work

Using a computer keyboard with the forearms unsupported has been proposed as a causal factor for neck/shoulder and arm/hand diagnoses. Recent laboratory and field studies have demonstrated that forearm support might be preferable to working in the traditional floating posture. The aim of this study was to determine whether providing forearm Support when using a normal computer workstation would decrease musculoskeletal discomfort in intensive computer users in a call centre. A randomised controlled study (n = 59), of 6 weeks duration was conducted. Thirty participants (Group 1) were allocated to forearm support using the desk surface with the remainder (Group 2) acting as a control group. At 6 weeks, the control group was also set up with forearm support. Both groups were then monitored for another 6 weeks. Questionnaires were used at 1, 6 and 12 weeks to obtain information about discomfort, workstation setup, working posture and comfort. Nine participants (Group 1 n = 6, Group 2 n = 3) withdrew within a week of commencing forearm support either due to discomfort or difficulty in maintaining the posture. At 6 weeks, the group using forearm support generated significantly fewer reports of discomfort in the neck and back, although the difference between the groups was not statistically significant. At 12 weeks, there were fewer reports of neck, back and wrist discomfort when preintervention discomfort was compared with post intervention discomfort. These findings indicate that for the majority of users, forearm support may be preferable to the floating Posture implicit in current guidelines for computer workstation setup. (C) 2004 Elsevier Ltd. All rights reserved.

The estrogen receptor 1 G594A polymorphism is associated with migraine susceptibility in two independent case/control groups

Migraine is a painful and debilitating disorder with a significant genetic component. Steroid hormones, in particular estrogen, have long been considered to play a role in migraine, as variations in hormone levels are associated with migraine onset in many sufferers of the disorder. Steroid hormones mediate their activity via hormone receptors, which have a wide tissue distribution. Estrogen receptors have been localized to the brain in regions considered to be involved in migraine pathogenesis. Hence it is possible that genetic variation in the estrogen receptor gene may play a role in migraine susceptibility. This study thus examined the estrogen receptor 1 (ESRalpha) gene for a potential role in migraine pathogenesis and susceptibility. A population-based cohort of 224 migraine sufferers and 224 matched controls were genotyped for the G594A polymorphism located in exon 8 of the ESR1 gene. Statistical analysis indicated a significant difference between migraineurs and non-migraineurs in both the allele frequencies (P=0.003) and genotype distributions (P=0.008) in this sample. An independent follow-up study was then undertaken using this marker in an additional population-based cohort of 260 migraine sufferers and 260 matched controls. This resulted in a significant association between the two groups with regard to allele frequencies (P=8x10(-6)) and genotype distributions (P=4x10(-5)). Our findings support the hypothesis that genetic variation in hormone receptors, in particular the ESR1 gene, may play a role in migraine.

Attitudes towards the sexuality of adults with an intellectual disability: parents, support staff, and a community sample

Attitudes toward the sexuality of adults with intellectual disability were assessed in parents and carers of adults with intellectual disability and in a community sample. An instrument that contained items relating to eight aspects of sexuality (sexual feelings, sex education, masturbation, personal relationships, sexual intercourse, sterilisation, marriage, and parenthood) was developed and found to have good internal consistency and test-retest reliability. Age was associated with attitudes, with those aged 60 and above holding more conservative attitudes. Parents and staff differed in their attitudes, with parents holding more conservative attitudes. This difference was the product of age differences between the groups; nevertheless it may produce some confusion for adults with intellectual disability unless it is addressed appropriately. Both parent and staff groups were less positive about parenthood than about other aspects of sexuality, however the community group did not differ in their views when attitudes towards parenthood were compared with the remaining items Of the scale.

The impact of rehabilitation support services on health-related quality of life for women with breast cancer

As the number of women surviving breast cancer increases, with implications for the health system, research into the physical and psychosocial sequelae of the cancer and its treatment is a priority. This research estimated self-reported health-related quality of life (HRQoL) associated with two rehabilitation interventions for breast cancer survivors, compared to a non-intervention group. Women were selected if they received an early home-based physiotherapy intervention (DAART, n = 36) or a group-based exercise and psychosocial intervention (STRETCH, n = 31). Questionnaires on HRQoL, using the Functional Assessment of Cancer Therapy - Breast Cancer plus Arm Morbidity module, were administered at pre-, post-intervention, 6- and 12-months post-diagnosis. Data on a non-intervention group (n = 208) were available 6- and 12-months post-diagnosis. Comparing pre/post-intervention measures, benefits were evident for functional well-being, including reductions in arm morbidity and upper-body disability for participants completing the DAART service at one-to-two months following diagnosis. In contrast, minimal changes were observed between pre/post-intervention measures for the STRETCH group at approximately 4-months post-diagnosis. Overall, mean HRQoL scores (adjusted for age, chemotherapy, hormone therapy, high blood pressure and occupation type) improved gradually across all groups from 6- to 12-months post-diagnosis, and no prominent differences were found. However, this obscured declining HRQoL scores for 20-40% of women at 12 months post-diagnosis, despite receiving supportive care services. Greater awareness and screening for adjustment problems among breast cancer survivors is required throughout the disease trajectory. Early physiotherapy after surgery has the potential for short-term functional, physical and overall HRQoL benefits.

A cost-effectiveness analysis of two rehabilitation support services for women with breast cancer

The purpose of this research was to estimate the cost-effectiveness of two rehabilitation interventions for breast cancer survivors, each compared to a population-based, non-intervention group (n = 208). The two services included an early home-based physiotherapy intervention (DAART, n = 36) and a group-based exercise and psychosocial intervention (STRETCH, n = 31). A societal perspective was taken and costs were included as those incurred by the health care system, the survivors and community. Health outcomes included: (a) 'rehabilitated cases' based on changes in health-related quality of life between 6 and 12 months post-diagnosis, using the Functional Assessment of Cancer Therapy - Breast Cancer plus Arm Morbidity (FACT-B+4) questionnaire, and (b) quality-adjusted life years (QALYs) using utility scores from the Subjective Health Estimation (SHE) scale. Data were collected using self-reported questionnaires, medical records and program budgets. A Monte-Carlo modelling approach was used to test for uncertainty in cost and outcome estimates. The proportion of rehabilitated cases was similar across the three groups. From a societal perspective compared with the non-intervention group, the DAART intervention appeared to be the most efficient option with an incremental cost of $1344 per QALY gained, whereas the incremental cost per QALY gained from the STRETCH program was $14,478. Both DAART and STRETCH are low-cost, low-technological health promoting programs representing excellent public health investments.

Pressure support ventilation with the ProSeal (R) laryngeal mask airway. A comparison of sevoflurane, isoflurane and propofol

Background and objective: There are no data about the influence of anaesthetics on cardiovascular variables during pressure support ventilation of the lungs through the laryngeal mask airway. We compared propofol, sevoflurane and isoflurane for maintenance of anaesthesia with the ProSeal (R) laryngeal mask airway during pressure support ventilation. Methods: Sixty healthy adults undergoing peripheral musculo-skeletal surgery were randomized for maintenance with sevoflurane end-tidal 29%, isoflurane end-tidal 1.1% or propofol 6 mg kg(-1) h(-1) in oxygen 33% and air. Pressure support ventilation comprised positive end-expiratory pressure set at 5 cmH(2)O, and pressure support set 5 cmH(2)O above positive end-expiratory pressure. Pressure support was initiated when inspiration produced a 2 cmH(2)O reduction in airway pressure. A blinded observer recorded cardiorespiratory variables (heart rate, mean blood pressure, oxygen saturation, air-way occlusion pressure, respiratory rate, expired tidal volume, expired minute volume and end-tidal CO2), adverse events and emergence times. Results: Respiratory rate and minute volume were 10-21% lower, and end-tidal CO2 6-11% higher with the propofol group compared with the sevoflurane or isoflurane groups, but otherwise cardiorespiratory variables were similar among groups. No adverse events occurred in any group. Emergence times were longer with the propofol group compared with the sevoflurane or isoflurane groups (10 vs. 7 vs. 7 min). Conclusion: Lung ventilation is less effective and emergence times are longer with propofol than sevoflurane or isoflurane for maintenance of anaesthesia during pressure support ventilation with the ProSeal (R) laryngeal mask airway. However, these differences are small and of doubtful clinical importance.

Effective leadership in salient groups: Revisiting leader-member exchange theory from the perspective of the social identity theory of leadership

Two studies compared leader-member exchange (LMX) theory and the social identity theory of leadership. Study 1 surveyed 439 employees of organizations in Wales, measuring Work group salience, leader-member relations, and perceived leadership effectiveness. Study 2 surveyed 128 members of organizations in India, measuring identification not salience and also individualism/collectivism. Both studies provided good support for social identity predictions. Depersonalized leader-member relations were associated with greater leadership effectiveness among high- than low-salient groups (Study 1) and among high than low identifiers (Study 2). Personalized leadership effectiveness was less affected by salience (Study 1) and unaffected by identification (Study 2). Low-salience groups preferred personalized leadership more than did high-salience groups (Study 1). Low identifiers showed no preference but high identifiers preferred depersonalized leadership (Study 2). In Study 2, collectivists did not Prefer depersonalized as opposed to personalized leadership, whereas individualists did, probably because collectivists focus more on the relational self.

Instruction to support mental computation development in young children of diverse ability

Fostering young children's mental computation capacity is essential to support their numeracy development. Debate continues as to whether young children should be explicitly taught strategies for mental computation, or be afforded the freedom to develop their own. This paper reports on teaching experiments with two groups of students in their first year of schooling: those considered 'at-risk', and those deemed mathematically advanced. Both groups made considerable learning gains as a result of instruction. Importantly, the gains of the at-risk group are likely to renew both their own, and their teacher's confidence in their ability to learn. In this paper, the instructional programs are documented, highlighting the influence of instruction upon the children's development.

Using process mapping and business process simulation to support a process-based approach to change in a public sector organisation

A case study demonstrates the use of a process-based approach to change regarding the implementation of an information system for road traffic accident reporting in a UK police force. The supporting tools of process mapping and business process simulation are used in the change process and assist in communicating the current process design and people's roles in the overall performance of that design. The simulation model is also used to predict the performance of new designs incorporating the use of information technology. The approach is seen to have a number of advantages in the context of a public sector organisation. These include the ability for personnel to move from a traditional grouping of staff in occupational groups with relationships defined by reporting requirements to a view of their role in a process, which delivers a performance to a customer. By running the simulation through time it is also possible to gauge how changes at an operational level can lead to the meeting of strategic targets over time. Also the ability of simulation to proof new designs was seen as particularly important in a government agency were past failures of information technology investments had contributed to a more risk averse approach to their implementation. © 2004 Elsevier Ltd. All rights reserved.

Effective leadership in salient groups:revisiting leader-member exchange theory from the perspective of the social identity theory of leadership

Two studies compared leader-member exchange (LMX) theory and the social identity theory of leadership. Study 1 surveyed 439 employees of organizations in Wales, measuring work group salience, leader-member relations, and perceived leadership effectiveness. Study 2 surveyed 128 members of organizations in India, measuring identification not salience and also individualism/collectivism. Both studies provided good support for social identity predictions. Depersonalized leader-member relations were associated with greater leadership effectiveness among high-than low-salient groups (Study 1) and among high than low identifiers (Study 2). Personalized leadership effectiveness was less affected by salience (Study 1) and unaffected by identification (Study 2). Low-salience groups preferred personalized leadership more than did high-salience groups (Study 1). Low identifiers showed no preference but high identifiers preferred depersonalized leadership (Study 2). In Study 2, collectivists did not prefer depersonalized as opposed to personalized leadership, whereas individualists did, probably because collectivists focus more on the relational self.

Ethnic diversity as a multilevel construct:the combined effects of dissimilarity, group diversity, and societal status on learning performance in work groups

The authors present a model of the multilevel effects of diversity on individual learning performance in work groups. For ethnically diverse work groups, the model predicts that group diversity elicits either positive or negative effects on individual learning performance, depending on whether a focal individual’s ethnic dissimilarity from other group members is high or low. By further considering the societal status of an individual’s ethnic origin within society (Anglo versus non-Anglo for our U.K. context), the authors hypothesize that the model’s predictions hold more strongly for non-Anglo group members than for Anglo group members. We test this model with data from 412 individuals working on a 24-week business simulation in 87 four- to seven-person groups with varying degrees of ethnic diversity. Two of the three hypotheses derived from the model received full support and one hypothesis received partial support. Implications for theory development, methods, and practice in applied group diversity research are discussed.

Automatic indexing and retrieval of encounter-specific evidence for point-of-care support

Evidence-based medicine relies on repositories of empirical research evidence that can be used to support clinical decision making for improved patient care. However, retrieving evidence from such repositories at local sites presents many challenges. This paper describes a methodological framework for automatically indexing and retrieving empirical research evidence in the form of the systematic reviews and associated studies from The Cochrane Library, where retrieved documents are specific to a patient-physician encounter and thus can be used to support evidence-based decision making at the point of care. Such an encounter is defined by three pertinent groups of concepts - diagnosis, treatment, and patient, and the framework relies on these three groups to steer indexing and retrieval of reviews and associated studies. An evaluation of the indexing and retrieval components of the proposed framework was performed using documents relevant for the pediatric asthma domain. Precision and recall values for automatic indexing of systematic reviews and associated studies were 0.93 and 0.87, and 0.81 and 0.56, respectively. Moreover, precision and recall for the retrieval of relevant systematic reviews and associated studies were 0.89 and 0.81, and 0.92 and 0.89, respectively. With minor modifications, the proposed methodological framework can be customized for other evidence repositories. © 2010 Elsevier Inc.