Work in inflammatory and degenerative joint diseases

This article focuses on work disability and sick leave and their cost; it also discusses the value of vocational rehabilitation programmes in rheumatic conditions such as rheumatoid arthritis, ankylosing spondylitis, hip and knee osteoarthritis. It acknowledges the importance of work not only for the worker who has one of these diseases but also for the public purse. Much can be done to improve the health of the persons and reduce their disability and its impact in the workplace which will have an important effect on their and their family's quality of life. It is important that neither rehabilitation nor vocational rehabilitation are regarded as bolt-on activities after drug treatment but are seen as an integral part of effective management. Publications dealing with return to work are relatively common in rheumatoid arthritis, less common in ankylosing spondylitis and relatively rare in osteoarthritis. Vocational rehabilitation programmes should aim to facilitate job retention or, failing that, to improve the ability to return to work. The process must be started with in the health arena and it has to be recognised that slow or poor practice in the health service can jeopardise the patient's work potential

Prevalence of Burnout syndrome in health professionals of an onco-hematological pediatric hospital

OBJECTIVE To identify the prevalence of Burnout Syndrome in medical professionals, nurses and nursing technicians working in an Onco-Hematological Pediatric Hospital in São Paulo. METHOD An exploratory, descriptive study with cross-sectional design and quantitative approach, with a sample of 188 health professionals. Data were collected using two self-report instruments: the Maslach Burnout Inventory (MBI-HSS) which is a biosocial data form, and a non-participant observation guide. RESULTS High depersonalization for nurses (29.8%), low job performance for physicians (27.8%), and of nursing technicians (25.5%). High scores were identified in at least two domains of Burnout in 19.2% of nurses, 16.8% of nursing technicians, and 16.6% of doctors. CONCLUSION Health professionals are highly vulnerable to each of the dimensions of Burnout syndrome - namely emotional exhaustion, alienation, and low job performance/satisfaction- in the hospital work.

Pleasure-suffering indicators of nursing work in a hemodialysis nursing service

OBJECTIVE To measure the pleasure and suffering indicators at work and relate them to the socio-demographic and employment characteristics of the nursing staff in a hemodialysis center in southern Brazil. METHOD Quantitative research, with 46 workers. We used a self-completed form with demographic and labor data and the Pleasure and Suffering Indicators at Work Scale (PSIWS). We conducted a bivariate and correlation descriptive analysis with significance levels of 5% using the Epi-Info® and PredictiveAnalytics Software programs. RESULTS Freedom of Speech was considered critical; other factors were evaluated as satisfactory. The results revealed a possible association between sociodemographic characteristics and work, and pleasure and suffering indicators. There was a correlation between the factors evaluated. CONCLUSION Despite the satisfactory evaluation, suffering is present in the studied context, expressed mainly by a lack of Freedom of Speech, with the need for interventions to prevent injury to the health of workers.

How binding are legal limits? Transitions from temporary to permanent work in Spain

This paper studies the duration pattern of xed-term contracts and the determinantsof their conversion into permanent ones in Spain, where the share of xed-termemployment is the highest in Europe. We estimate a duration model for temporaryemployment, with competing risks of terminating into permanent employment versusalternative states, and exible duration dependence. We nd that conversion rates aregenerally below 10%. Our estimated conversion rates roughly increase with tenure,with a pronounced spike at the legal limit, when there is no legal way to retain theworker on a temporary contract. We argue that estimated di¤erences in conversionrates across categories of workers can stem from di¤erences in worker outside optionsand thus the power to credibly threat to quit temporary jobs.

Le médecin face aux inégalités sociales de santé: quel pouvoir d'action [General practitioners facing social inequalities in health: which power to act?].

The link between social inequalities and health has been known for many years, as attested by Villermé's work on the "mental and physical status of the working class" (1840). We have more and more insight into the nature of this relationship, which embraces not only material deprivation, but also psychological mechanisms related to social and interpersonal problems. Defining our possible role as physicians to fight against these inequalities has become a public health priority. Instruments and leads, which are now available to help us in our daily practice, are presented here.

La Generation Sandwich en Suisse Romande: mieux comprendre les facteurs associés avec la santé perçue afin de mieux agir en promotion de la santé [Sandwich Generation in Roman Switzerland : a better understanding of factors linked with perceived health for better acting in health promotion].

The so-called < Sandwich Generation > (SG) is characterized by concurrent and competing professional, familial, and informal caregiving workloads. These stressors pose potential health risks. However, the current knowledge about SG characteristics and perceived state of health are insufficient to allow occupational health nurses to develop evidence-based interventions designed for health promotion. We aimed to describe this population and examine the relationships between these coexisting workloads and their perceived health. This study is based on a descriptive, correlational design. Employees of a Swiss public administration completed an electronic questionnaire. Of 844 respondents, 23 % are SG members. Ages of frailed parents or parents-in-law, co-residence with the latters, children still living at home predict that employees could be members of the SG. Perceived physical health status of SG members is rated better than mental health status. The heterogeneity of SG is reflected in three clusters. Finally, physical health score is the only that differs from the other health scores adjusting for clusters and sex. This study provides a foundation for developing preventive interventions targeting the SG.

Symptoms of chronic stress at work in NGO workers

Working in a NGO often involves providing life saving resources (food, medicine, equipment, water, etc) to needy populations around the globe. Such duty requires highly dedicated employees and humanitarian workers are said to face a hign degree of pressure in their daily work. Despite the evidence of taxing work demands, and a high potential for stress related problems, very few studies on occupational chronic stress have specifically looked at NGO workers. Assuming that "field stress" can relay to workers at headquarters, we carried out an exploratory study about occupational health among employees of a NGO's headquarters. We sent a questionnaire to all employees (N=130) of a NGO headquarters located in Switzerland. We used the TST questionnaire (French version of the Langner's questionnaire on psychiatric symptoms) to identify cases with potential mental health problems. We also included in the questionnaire some items about motivation, acknowledgment, work-life balance, job demand, and autonomy. A total of 75 employees answered our questionnaire (57% response rate). 44% of our sample were men (n=33) and 56% were women (n=42). The mean age was of 40 years (SD=7.6). 56% were working at the headquarters of the NGO in questions as of 2 years or less. Not surprisingly, a majority of respondents reported to be highly motivated (74%) and the meaning of work was important for 80% of them. However, 35% indicated having problems in conciliating their private and professional life. Most frequent reported symptoms included feeling "weak all over" (81%), having "trouble getting asleep often" (35%), "clogging in nose" (35%), feeling "nervous often" (33%), and "memory not all right" (33%). The score for psychiatric symptoms was high in 8 (11%) employees whose health might therefore be at risk. In comparison, other sudies showed that this proportion was 9% for French teachers and 16% for sales personnel1. Results show that symptoms of mental health problems do occur among NGO workers. Some of these symptoms are known to be linked to occupational stress. Chronic stress manifests itself first in non-specific symptoms (e.g. fatigue) and later in specific pathologies. This could explain the relatively low proportion of cases with a high score in Langner's scale than was expected. Therefore, we hypothesize a healthy worker effect. The fact that our sample is 40 years old in average, and that the turnover is quite high can also support this hypothesis. Further research is needed in order to better understand occupational stress in this specific population. An upcoming study will investigate the role of organizational factors associated with health complaints. Therefore, a longitudinal survey including quantitative and qualitative methods is appropriate.

Utilizing Near Field Communication in Health Care

In this master’s thesis, possibilities to utilize Near Field Communication (NFC) technology in health care applications are examined. NFC is a short-range wireless communication technology that enables the exchange of data between devices. Main components in NFC are tag, which contains data, a NFC reader device, which can be for instance embedded to mobile phone and also act as a tag, and an antennae in both tag and reader. In this work NFC technology is discussed and its utilization in health care information systems that are in use or in trial. Utilization of information technology in health care field is examined superficially. In this thesis, a system utilizing NFC is designed and its requirements and architecture presented. NFC is used in identification of care worker. When care worker arrives at the house of a patient, she brings the NFC-enabled mobile phone near NFC tag. This sends information to the application server. This information contains the time of arrival and patient and location identifier. When care worker leaves the place, she repeats the procedure. Information gathered can be used in reporting and real time tracking.

A Phenomenological Study Exploring the Experiences of Men Who Work in Maternal-Newborn Nursing Positions

The aim of this study was to explore the experiences of men who choose to work in maternal-newborn nursing roles. Using a qualitative phenomenological approach, interviews were conducted with a purposeful sample of six male nurses who worked in maternal-newborn settings using a semi-structured guide. Four themes emerged: Motivation and Influences in Career Choice, Barriers to Developing Caring Confidence as Maternal-Newborn Nurses, Surviving as Men in Maternal-Newborn Nursing, and The Invisible Norms Associated with Men in Maternal-Newborn Nursing. The study generated meaning surrounding career selection and addressed motivating factors such as role modeling, life experience, and passion for the area of specialization or convenience. There is importance in understanding the experiences of men who choose to work in maternal-newborn nursing roles. Thus, this research has implications for nursing, practice, education, and research, particularly with nursing leadership, policy makers, educators, guidance counselors, and men considering maternal-newborn nursing roles.

Considering daily mobility in contextual studies of social inequalities in health : conceptual and empirical insights

Les études sur les milieux de vie et la santé ont traditionnellement porté sur le seul quartier de résidence. Des critiques ont été émises à cet égard, soulignant le fait que la mobilité quotidienne des individus n’était pas prise en compte et que l’accent mis sur le quartier de résidence se faisait au détriment d’autres milieux de vie où les individus passent du temps, c’est-à-dire leur espace d’activité. Bien que la mobilité quotidienne fasse l’objet d’un intérêt croissant en santé publique, peu d’études se sont intéressé aux inégalités sociales de santé. Ceci, même en dépit du fait que différents groupes sociaux n’ont pas nécessairement la même capacité à accéder à des milieux favorables pour la santé. Le lien entre les inégalités en matière de mobilité et les inégalités sociales de santé mérite d’être exploré. Dans cette thèse, je développe d'abord une proposition conceptuelle qui ancre la mobilité quotidienne dans le concept de potentiel de mobilité. Le potentiel de mobilité englobe les opportunités et les lieux que les individus peuvent choisir d’accéder en convertissant leur potentiel en mobilité réalisée. Le potentiel de mobilité est façonné par des caractéristiques individuelles (ex. le revenu) et géographiques (ex. la proximité des transports en commun), ainsi que par des règles régissant l’accès à certaines ressources et à certains lieux (ex. le droit). Ces caractéristiques et règles sont inégalement distribuées entre les groupes sociaux. Des inégalités sociales en matière de mobilité réalisée peuvent donc en découler, autant en termes de l'ampleur de la mobilité spatiale que des expositions contextuelles rencontrées dans l'espace d'activité. Je discute de différents processus par lesquels les inégalités en matière de mobilité réalisée peuvent mener à des inégalités sociales de santé. Par exemple, les groupes défavorisés sont plus susceptibles de vivre et de mener des activités dans des milieux défavorisés, comparativement à leurs homologues plus riches, ce qui pourrait contribuer aux différences de santé entre ces groupes. Cette proposition conceptuelle est mise à l’épreuve dans deux études empiriques. Les données de la première vague de collecte de l’étude Interdisciplinaire sur les inégalités sociales de santé (ISIS) menée à Montréal, Canada (2011-2012) ont été analysées. Dans cette étude, 2 093 jeunes adultes (18-25 ans) ont rempli un questionnaire et fourni des informations socio-démographiques, sur leur consommation de tabac et sur leurs lieux d’activités. Leur statut socio-économique a été opérationnalisé à l’aide de leur plus haut niveau d'éducation atteint. Les lieux de résidence et d'activité ont servi à créer des zones tampons de 500 mètres à partir du réseau routier. Des mesures de défavorisation et de disponibilité des détaillants de produits du tabac ont été agrégées au sein des ces zones tampons. Dans une première étude empirique je compare l'exposition à la défavorisation dans le quartier résidentiel et celle dans l'espace d’activité non-résidentiel entre les plus et les moins éduqués. J’identifie également des variables individuelles et du quartier de résidence associées au niveau de défavorisation mesuré dans l’espace d’activité. Les résultats démontrent qu’il y a un gradient social dans l’exposition à la défavorisation résidentielle et dans l’espace d’activité : elle augmente à mesure que le niveau d’éducation diminue. Chez les moins éduqués les écarts dans l’exposition à la défavorisation sont plus marquées dans l’espace d’activité que dans le quartier de résidence, alors que chez les moyennement éduqués, elle diminuent. Un niveau inférieur d'éducation, l'âge croissant, le fait d’être ni aux études, ni à l’emploi, ainsi que la défavorisation résidentielle sont positivement corrélés à la défavorisation dans l’espace d’activité. Dans la seconde étude empirique j'étudie l'association entre le tabagisme et deux expositions contextuelles (la défavorisation et la disponibilité de détaillants de tabac) mesurées dans le quartier de résidence et dans l’espace d’activité non-résidentiel. J'évalue si les inégalités sociales dans ces expositions contribuent à expliquer les inégalités sociales dans le tabagisme. J’observe que les jeunes dont les activités quotidiennes ont lieu dans des milieux défavorisés sont plus susceptibles de fumer. La présence de détaillants de tabac dans le quartier de résidence et dans l’espace d’activité est aussi associée à la probabilité de fumer, alors que le fait de vivre dans un quartier caractérisé par une forte défavorisation protège du tabagisme. En revanche, aucune des variables contextuelles n’affectent de manière significative l’association entre le niveau d’éducation et le tabagisme. Les résultats de cette thèse soulignent l’importance de considérer non seulement le quartier de résidence, mais aussi les lieux où les gens mènent leurs activités quotidiennes, pour comprendre le lien entre le contexte et les inégalités sociales de santé. En discussion, j’élabore sur l’idée de reconnaître la mobilité quotidienne comme facteur de différenciation sociale chez les jeunes adultes. En outre, je conclus que l’identification de facteurs favorisant ou contraignant la mobilité quotidienne des individus est nécessaire afin: 1 ) d’acquérir une meilleure compréhension de la façon dont les inégalités sociales en matière de mobilité (potentielle et réalisée) surviennent et influencent la santé et 2) d’identifier des cibles d’intervention en santé publique visant à créer des environnements sains et équitables.

Preliminary Study on Safety Conditions in Health Workers Exposed to Antineoplastic Drugs

A study was done to establish work practices and preventive measures for nurses handling antineoplasticdrugs (AND) and to determine the risk of developing AND-related symptoms. A descriptive cross sectional study was made. Workers from 5 health centers in Valencia, Venezuela, were selected. Demography, occupational and clinical history, shift, work practices, safety precautions, antineoplastic drugs used, residues disposal and life styles were obtained via a questionnaire. Most prevalent symptoms were adjusted for age, shift, and smoking. Age was significant for cough and dizziness; smoking was significant for abdomipo seleccionado de trabajadores que manejan FAN en cinco centros de salud de la ciudad de Valencia, Venezuela, con el propósito de evaluar de forma preliminar su riesgo potencial de desarrollar signos-síntomas derivados de este oficio; a su vez, establecer si existe la necesidad de continuar con una evaluación más profunda que permita hacer recomendaciones concluyentes para evitar sus efectos adversos. Metodología La población estuvo constituida por el personal de las unidades de oncología de cinco centros de salud de la ciudad de Valencia, Venezuela. La muestra la conformaron veinte trabajadores que pertenecen a dichos centros. La participación fue voluntaria y mediante firma de una carta de consentimiento. Recolección de datos Se realizó una entrevista a cada participante con información que hizo referencia a datos demográficos, historia ocupacional, turnos de trabajo, entrenamiento en medidas de seguridad para el manejo de este tipo de fármacos, actividades que realizan, uso de equipos de protección personal (EPP), sitio de manipulación de nal pain and shift was significant for nausea and cough. Nauseas were the most prevalent symptom (55%). Dizziness was directly associated with use of gowns and inversely half-face respirator. None of the studied centers had satisfactory working conditions. A follow up study should be made including physical exam and environmental and biological monitoring.

Prevalence and factors associated with dysmenorrheal in health science students

Introduction: Dysmenorrhea has a prevalence between 60 and 93%. Different factors have been associated with it, such as age at menarche, body mass index, exercise, smoking and maternal history of dysmenorrhea, among others. Materials and methods: A cross-sectional study was conducted, based on an anonymous survey applied to a random sample of 127 women from the school of medicine and psychology at the Universidad Del Rosario. Results: The prevalence of  dysmenorrhea was 73%. 67% of participants presenting with menstrual pain, reported having taken pain relief medication (66.7% self medicated). 32.5% of respondents with dysmenorrhea were absent from their academic or social work, with a percentage of school absenteeism due to pain of 74.5% in at least one day. The risk of dysmenorrhoea was 2.36 times higher in women who had mothers with this history (OR = 2.36, 95% CI 1.03 to 5.40). No associations with other factors were found. Conclusions: Dysmenorrhea is a disease with a high prevalence and significant impact on school absenteeism. Maternal history of dysmenorrhea was the only factor positively associated in this study.

Human microbiota in health and disease

Each human body plays host to a microbial population which is both numerically vast (at around 1014 microbial cells) and phenomenally diverse (over 1,000 species). The majority of the microbial species in the gut have not been cultured but the application of culture-independent approaches for high throughput diversity and functionality analysis has allowed characterisation of the diverse microbial phylotypes present in health and disease. Studies in monozygotic twins, showing that these retain highly similar microbiota decades after birth and initial colonisation, are strongly indicative that diversity of the microbiome is host-specific and affected by the genotype. Microbial diversity in the human body is reflected in both richness and evenness. Diversity increases steeply from birth reaching its highest point in early adulthood, before declining in older age. However, in healthy subjects there appears to be a core of microbial phylotypes which remains relatively stable over time. Studies of individuals from diverse geopraphies suggest that clusters of intestinal bacterial groups tend to occur together, constituting ‘enterotypes’. So variation in intestinal microbiota is stratified rather than continuous and there may be a limited number of host/microbial states which respond differently to environmental influences. Exploration of enterotypes and functional groups may provide biomarkers for disease and insights into the potential for new treatments based on manipulation of the microbiome. In health, the microbiota interact with host defences and exist in harmonious homeostasis which can then be disturbed by invading organisms or when ‘carpet bombing’ by antibiotics occurs. In a portion of individuals with infections, the disease will resolve itself without the need for antibiotics and microbial homeostasis with the host’s defences is restored. The administration of probiotics (live microorganisms which when administered in adequate amounts confer a health benefit on the host) represents an artificial way to enhance or stimulate these natural processes. The study of innate mechanisms of antimicrobial defence on the skin, including the production of numerous antimicrobial peptides (AMPs), has shown an important role for skin commensal organisms. These organisms may produce AMPs, and also amplify the innate immune responses to pathogens by activating signalling pathways and processing host produced AMPs. Research continues into how to enhance and manipulate the role of commensal organisms on the skin. The challenges of skin infection (including diseases caused by multiply resistant organisms) and infestations remain considerable. The potential to re-colonise the skin to replace or reduce pathogens, and exploring the relationship between microbiota elsewhere and skin diseases are among a growing list of research targets. Lactobacillus species are among the best known ‘beneficial’ bacterial members of the human microbiota. Of the approximately 120 species known, about 15 are known to occur in the human vagina. These organisms have multiple properties, including the production of lactic acid, hydrogen peroxide and bacteriocins, which render the vagina inhospitable to potential pathogens. Depletion of the of the normal Lactobacillus population and overgrowth of vaginal anaerobes, accompanied by the loss of normal vaginal acidity can lead to bacterial vaginosis – the commonest cause of abnormal vaginal discharge in women. Some vaginal anaerobes are associated with the formation of vaginal biofilms which serve to act as a reservoir of organisms which persists after standard antibiotic therapy of bacterial vaginosis and may help to account for the characteristically high relapse rate in the condition. Administration of Lactobacillus species both vaginally and orally have shown beneficial effects in the treatment of bacterial vaginosis and such treatments have an excellent overall safety record. Candida albicans is a frequent coloniser of human skin and mucosal membranes, and is a normal part of the microbiota in the mouth, gut and vagina. Nevertheless Candida albicans is the most common fungal pathogen worldwide and is a leading cause of serious and often fatal nosocomial infections. What turns this organism from a commensal to a pathogen is a combination of increasing virulence in the organism and predisposing host factors that compromise immunity. There has been considerable research into the use of probiotic Lactobacillus spp. in vaginal candidiasis. Studies in reconstituted human epithelium and monolayer cell cultures have shown that L. rhamnosus GG can protect mucosa from damage caused by Candida albicans, and enhance the immune responses of mucosal surfaces. Such findings offer the promise that the use of such probiotic bacteria could provide new options for antifungal therapy. Studies of changes of the human intestinal microbiota in health and disease are complicated by its size and diversity. The Alimentary Pharmabiotic Centre in Cork (Republic of Ireland) has the mission to ‘mine microbes for mankind’ and its work illustrates the potential benefits of understanding the gut microbiota. Work undertaken at the centre includes: mapping changes in the microbiota with age; studies of the interaction between the microbiota and the gut; potential interactions between the gut microbiota and the central nervous system; the potential for probiotics to act as anti-infectives including through the production of bacteriocins; and the characterisation of interactions between gut microbiota and bile acids which have important roles as signalling molecules and in immunity. The important disease entity where the role of the gut microbiota appears to be central is the Irritable Bowel Syndrome (IBS). IBS patients show evidence of immune activation, impaired gut barrier function and abnormal gut microbiota. Studies with probiotics have shown that these organisms can exert anti-inflammatory effects in inflammatory bowel disease and may strengthen the gut barrier in IBS of the diarrhoea-predominant type. Formal randomised trials of probiotics in IBS show mixed results with limited benefit for some but not all. Studies confirm that administered probiotics can survive and temporarily colonise the gut. They can also stimulate the numbers of other lactic acid bacilli in the gut, and reduce the numbers of pathogens. However consuming live organisms is not the only way to influence gut microbiota. Dietary prebiotics are selectively fermented ingredients that can change the composition and/or activity of the gastrointestinal microbiota in beneficial ways. Dietary components that reach the colon, and are available to influence the microbiota include poorly digestible carbohydrates, such as non-starch polysaccharides, resistant starch, non-digestible oligosaccharides (NDOs) and polyphenols. Mixtures of probiotic and prebiotic ingredients that can selectively stimulate growth or activity of health promoting bacteria have been termed ‘synbiotics’. All of these approaches can influence gut microbial ecology, mainly to increase bifidobacteria and lactobacilli, but metagenomic approaches may reveal wider effects. Characterising how these changes produce physiological benefits may enable broader use of these tactics in health and disease in the future. The current status of probiotic products commercially available worldwide is less than ideal. Prevalent problems include misidentification of ingredient organisms and poor viability of probiotic microorganisms leading to inadequate shelf life. On occasions these problems mean that some commercially available products cannot be considered to meet the definition of a probiotic product. Given the potential benefits of manipulating the human microbiota for beneficial effects, there is a clear need for improved regulation of probiotics. The potential importance of the human microbiota cannot be overstated. ‘We feed our microbes, they talk to us and we benefit. We just have to understand and then exploit this.’ (Willem de Vos).

Ethics of care in supporting disabled forced migrants: interactions with professionals and ethical dilemmas in health and social care in the South-East of England

This article explores the interactions between disabled forced migrants with care needs and professionals and the restrictive legal, policy and practice context that health and social care professionals have to confront, based on the findings of a qualitative study with 45 participants in the South-East of England. In-depth interviews were conducted with 15 forced migrants who had diverse impairments and chronic illnesses (8 women and 7 men), 13 family caregivers and 17 support workers and strategic professionals working in social care and the third sector in Slough, Reading and London. The legal status of forced migrants significantly affects their entitlements to health and social care provision, resulting in prolonged periods of destitution for many families. National asylum support policies, difficult working relationships with UK Border Agency, higher eligibility thresholds and reduced social care budgets of local authorities were identified as significant barriers in responding to the support needs of disabled forced migrants and family caregivers. In this context, social workers experienced considerable ethical dilemmas. The research raises profound questions about the potential and limitations of health and social care policies, provision, and practice as means of protection and support in fulfilling the human rights of forced migrants with care needs.