Perception de la tension au travail (job strain) en milieu hospitalier à Pointe-Noire, Congo-Brazzaville / Perception of job strain in the hospital environment at Pointe-Noire, Congo-Brazzaville

Objectif : Evaluer la situation de job strain et les manifestations psychosomatiques ressenties par les personnels soignants des hôpitaux de Pointe-Noire. Méthodologie : L'étude était une enquête transversale analytique. Un auto-questionnaire monté selon le modèle « demande-contrôle-soutien ¼ de KARASEK, avait été utilisé pour recueillir de manière anonyme des données sociodémographiques, des informations relatives à l'état de santé, à leur poste de travail et d'identifier des facteurs de risques psychosociaux. Résultats : Sur l'ensemble des cent cinquante (150) soignants retenus, 47,02% présentaient une faible latitude décisionnelle contre 52,98% avec une forte latitude. La forte demande psychologique était perçue par 50,33% des soignants contre 49,67% avec une faible demande. La situation de job strain était retrouvée chez 26,67% des soignants. Les services des urgences et de médecine étaient les plus exposés avec respectivement 25% et 20% du personnel en situation de job strain. Une faible ancienneté au travail prédisposait à une perception de job strain plus élevée. Les médecins spécialistes et les infirmiers représentaient les catégories professionnelles les plus tendus avec respectivement 42,86% et 30,23% des individus concernés. Un lien statistique était retrouvé entre d'une part le job strain et d'autre part les troubles musculosquelettiques et l'auto-estimation de l'impact du travail sur la santé. Conclusion : Les risques psychosociaux notamment le stress sont une préoccupation réelle dans les établissements de soins et cette enquête a permis de noter qu'ils pourraient avoir des conséquences sur la santé des soignants à Pointe-Noire.

Objective: To assess the job strain situation and the psychosomatic manifestations felt by the health care worker of the Pointe-Noire hospitals. Methodology: It was an analytical cross-sectional survey. A self-questionnaire set up according to the KARASEK "demand-control-support" model had been used to anonymously collect sociodemographic data, information on their health situation, at their workplace and identify psychosocial risk factors. Results: of one hundred and fifty (150) caregivers considered, 47.02% had low decision latitude versus 52.98% with high latitude. The high psychological demand was felt by 50.33% of the medics versus 49.67% with a low demand. The job strain situation was found among 26.67% of medics. Emergency and medical departments were the most exposed with 25% and 20% of staff in a job-strain situation respectively. Low job seniority predisposed to a higher feeling of job-strain. Specialist doctors and nurses represented the most strained professional categories with 42.86% and 30.23% of the individuals concerned respectively. A statistical relation was found between job strain on the one hand and musculoskeletal trouble and self-estimation of the impact of work on health on the other hand. Conclusion: Psychosocial risks, particularly stress, are a real concern in health institutions and this survey note that there could be impact on medics' health in Pointe-Noire.

Perceived stressors of oral hygiene students in the dental environment

Background. University students are exposed to a multitude of stressors that may impact on their performance. The nature of health sciences education generally involves early engagement with patients and communities; which may add to the stressors inherent to university life. There is sparse information on stressors in the oral hygiene educational environment. Objective. To determine perceived stressors and the level of burnout among oral hygiene students at the University of the Western Cape; Cape Town; South Africa. Method. A descriptive; cross-sectional study design was used. The study sample included all students in the Bachelor of Oral Health (BOH) degree during 2012 (N=89). A self-administered questionnaire was used to gather data. Three parameters were measured; i.e. (i) demographic characteristics; (ii) perceived sources of stress; using a modified Dental Environment Stress (DES) questionnaire; and (iii) burnout; using the Maslach Burnout Inventory (MBI). Results. Respondents were mostly female (74%) and primarily in the 18 - 25-year age group (92%). First- and 2nd-year students identified fear of failing and study load as major stressors. Stressors related to a lack of basic needs were identified as major stressors by 25% of 1st-year students. Third-year students identified clinical quotas; supervision and patients being late as major stressors. MBI scores indicated that students were not at risk forburnout; however; most students (66.2%) scored high on emotional exhaustion (EE). Conclusion. Oral hygiene students identified stressors in their learning environment. There was a progressive increase in EE across academic years. The results suggest that interventions should be tailored for specific academic year groups

Parents Perceptions of Stress in a Neonatal Intensive Care Unit in Rwanda

Background: Having a newborn infant hospitalised in the neonatal intensive care unit (NICU) is an unexpected and stressful event for a family. A number of potential stressors to which family members of patients in these units may be exposed have been identified; although no studies about this issue have been conducted in Rwanda.Aim: The aim of this study was to describe and analyse parental perception of stress that resulted from having their infant admitted to a NICU in Kigali; Rwanda.Method: A quantitative survey was used to describe and analyse parents' perceptions of stress when they had an infant admitted to a NICU. The Parental Stress Scale: Neonatal Intensive Care Unit was used to measure the level of stress that those parents experienced.Results: The results indicated that parents experienced stress from having their infants cared for in a NICU. The most stressful events were the appearance and behaviour of the baby with a mean score of 4.02; whilst the subscale items related to sights and sounds were found to be the least significant source of stress for parents with a mean score of 2.51. In addition; the current study found that parents' age; educational level; occupation; and infant birth weight were associated with parental stress.Conclusion: The study established that a range of factors was responsible for parental stress when a baby was cared for in a NICU. Identification of these factors could enable health professionals from a hospital in Kigali; Rwanda; to facilitate parents' adjusting and coping

The Prevalence of Suicidal Behaviour and Associated Risk Factors in Grade 8 Learners in Durban

Objectives: Most of the research on suicidal behaviour in youth focuses on developed countries. Less is known about the prevalence of suicidal behaviour and associated risk factors in community samples of youth who do not present for mental health care in developing countries. This study investigated the prevalence of suicidal behaviour and associated risk factors in grade 8 learners in Durban. Setting and subjects: Grade 8 learners in a government-run; co-educational school were approached to participate in the study after parental consent and child assent were obtained. A descriptive; cross-sectional method was used to gather quantitative data. The grade 8 learners were asked to complete demographic questionnaires and various psychometric assessment scales. Design: The gathered data were divided into two groups; i.e. those who reported personal suicidal behaviour and those who did not. The various variables in these two groups were compared using bivariate and multivariate statistical analyses. Results: The study established that 22 participants (33.8; n = 75) reported suicidal behaviour (thoughts; plans or attempts in this regard). They also had higher levels of depression; perceived stress; hopelessness and anger (p-value 0.01) than those who did not report any suicidal behaviour. The same participants had lower scores on scales that assessed self-esteem and perceived social support from family (p-value 0.01); compared to those who did not report any suicidal behaviour. Logistic regression analysis that was undertaken indicated that a friend's suicidal thoughts [odds ratio (OR) 4.27; p-value 0.01]; alcohol use (OR 3.08; p-value 0.01); perceived stress (OR 1.05; p-value 0.01) and depression (OR 1.04; p-value 0.01); were strong predictors of personal suicidal behaviour in this sample. Conclusion: There is a high prevalence of suicidal behaviour in grade 8 learners in Durban. The identified risk factors were similar to those found in developed countries. Healthcare providers and other professionals; such as school counsellors; should consider the identified risk factors when assessing suicidality and planning interventions for youth

Associations between Family Suicide and Personal Suicidal Behaviour among Youth in Kwazulu-Natal; South Africa

Background: For every suicide; a minimum of six people are affected. Given the increasing number of suicide deaths in South Africa; the associations between the suicide of a family member and personal suicidal behaviour were explored in grade 8 students.Method: Grade 8 students were asked to participate with parental consent and child assent. Demographic questionnaires were completed and formal psychometric assessment instruments were used.Results: Thirty-five (15.98) students reported knowing that a family member had committed suicide. The mean age was 13.3 years (range 13-15 years). There were significant associations between family suicide and students' self-reported involvement in physical fights; use of alcohol and concerns about physical health. Family suicide was associated with personal suicidal ideation; suicidal plans and suicide attempts. Higher scores were reported on the scales assessing depression; perceived stress and feelings of hopelessness by those having had a family member commit suicide. There were low scores for having a sense of mastery; self-esteem and perceived social support among those who had experienced a family member commit suicide.Conclusion: Significant associations were found between the suicide of a family member and personal suicidal behaviour among the participants. There appear to be negative associations at a psychological level for the youth in a family in which a family member has committed suicide. Family practitioners play an important role in the identification and management of suicidal behaviour. While there are organisations in South Africa that offer help to the family and friends of those who have committed suicide; specific programmes directed towards child/adolescent survivors appear to be limited; and this needs to be addressed. The limitations of the study are discussed

Rolled Vaginal Wall Flap for the Treatment of Stress Urinary Incontinence

Objectives: Anterior vaginal wall slings (AVWS) have been used for decades in the treatment of female stress urinary incontinence (SUI). The main drawback of using the vaginal wall as a sling is its tendency to weaken and stretch over the course of years. The use of synthetic tapes for the treatment of SUI is effective but costly. For patients who cannot afford synthetic tapes; we describe the preliminary results of a modified AVWS technique for the treatment of SUI types II and III. Patients and Methods: In this series; a modification of the AVWS was applied in 35 female patients with SUI. A fortified and rolled flap is used to provide compression and support of the urethra. The vaginal mucosal surface of the flap is cauterized and two diagonal sutures are placed across it. The flap is then rolled on itself with a running 2/0 vicryl suture. Two sutures attached to both ends are passed retropubically to the anterior abdominal wall and tied over the rectus sheath. Results: All 35 female patients had type II/III SUI. After a median follow up of 43 months; 91of the patients were dry or used 0-1 pad per day. Only one patient suffered from transient retention for one week post-operatively. Conclusion: This is a simple method to reinforce vaginal wall flaps. It could offer a durable and effective option for the treatment of SUI in patients who can not afford synthetic tapes. Long-term follow up is required to evaluate the durability of the procedure

Injuries in Children and Adolescents seen during 2006 at the Emergency Department of the National District Hospital; Bloemfontein

Most children and adolescents recover fully from injuries. However; permanent disabilities may occur. The objective of the study was to investigate the prevalence and profile of injuries in children and adolescents five to 19 years of age seen at the emergency department of the National District Hospital in Bloemfontein. Methods: A retrospective descriptive study was conducted. Demographic and injury-specific information obtained from hospital records of 2006 was entered into a data-capturing form. Data were analysed by using descriptive statistics.and 43.5 of injuries occurred in the age group 15 to 19 years. Approximately half (51.7) were Afrikaans-speaking and resided in suburban areas (50). Most injuries occurred at home (40.2) between 12h00 and 17h00 (38.7). Falls (33.7) were the most common cause of injury. Soft tissue injuries (35.9) occurred most commonly; fol lowed by lacerations (33.0) and fractures (16.7). Upper limb injuries (42.1) were seen more than lower limb injuries (27.8). Facial injuries occurred in 12 of cases. X-rays were performed in 57.9 of cases. Most patients (93.3) received medication; while 22 were referred for specialist treatment. All cases except one were discharged from the emergency department. Parents accompanied patients in 65.6 of cases. Results: The prevalence of injuries in this age group was 20.3. Two hundred and nine records were investigated. The majority of cases were male (68.3). The median age was 15 years; Conclusions: Optimal treatment should be given to the injured child or adolescent to avoid possible long-term injuryrelated sequelae. Preventive strategies should be formulated; enforced and evaluated

The Experience and Psychosocial Needs of Patients with Traumatic Fractures Treated for More than Six Months at Doctors on Call for Service Hospital; Goma; Democratic Republic of Congo

Trauma-related consultations; admissions and complications are the leading problems at Doctors on Call for Service (DOCS) Hospital; Goma; Democratic Republic of Congo; and yet no studies have been carried out to document the experience of long-stay traumatic-fracture patients in this hospital. Aim: The aim of this study was to explore the experience and psychosocial needs of patients with traumatic fractures treated for more than six months at DOCS Hospital. Methods: Six free-attitude interviews were conducted with purposively selected patients. The interviews were recorded with a tape recorder and transcribed verbatim; and content analysis was used to identify themes from the interviews. Results: All patients could clearly connect the injury experience to severe pain that lingered on for weeks or months for some patients; accompanied by other symptoms such as insomnia; poor appetite and psychological symptoms. Most patients felt disabled; were abandoned by relatives or friends and experienced financial problems. Some benefited from the injury by way of strengthened marital links. Some patients complained of poor information about their illness and the management plan and did not appreciate the treatment from caregivers; while some disclosed their needs and expectations and appreciated the caregivers who showed interest in them. Conclusions: The experience of long-term trauma has negative effects on the whole person of the patient; including his or her work and family; and some patients continue to suffer from the effects of the traumatic event up to six months later. The needs of patients suffering from trauma include reassurance by physicians and nurses; more information and participation in the decision-making process; regular visits from friends and family; and better bedside manners from caregivers

Tension-Free Vaginal Tape Versus Transobturator Tape for Treatment of Female Stress Urinary Incontinence

The transobturator tape (TOT) is based on a similar principle as the tension-free vaginal tape (TVT); but introduced through the obturator foramen. The aim of this study was to compare these slings as surgical procedures for the treatment of stress urinary incontinence (SUI) in women. Patients and Methods This is a retrospective case-control study including female patients with SUI; either due to urethral hypermobility or intrinsic sphincter deficiency. Thirty patients were treated with TVT (group 1) and 30 were treated with TOT (group 2). The parameters studied were: pre-operative clinical data; operative data and surgical outcome. Results The post-operative complications in group 1 consisted of bladder perforation in one patient (3.3); urinary retention in 3 (10) and de novo urgency in 3 (10). The post-operative complications in group 2 consisted of vaginal xposure in 2 patients (6.7); de novo urgency in 2 (6.7) and transient urinary retention in one (3.3). In the TVT group; objective cure was achieved in 27/30 patients (90); while 3 patients (10) reported subjective cure; failure was not encountered. In the TOT group; objective cure was achieved in 24/30 patients (80) and subjective cure in 4 patients (13.3); and it failed in 2 patients (6.7). Conclusion TVT and TOT are effective procedures for the treatment of female SUI; with comparable results regarding operative time; hospital stay and the risk of complications

Emotional Reactions of Medical Doctors and Students Following the Loss of their Patients at the Dr George Mukhari Hospital Emergency Unit; South Africa

Background: Studies on death and dying predominantly emphasise the needs of the dying patient and the process of bereavement. Few studies have focused on the reactions of medical doctors and students when the patients they have cared for die. Methods: The aim of the study was to explore the thoughts and feelings of doctors and medical students who have lost patients while under their care at the Dr George Mukhari Hospital emergency unit in Ga-Rankuwa; South Africa. The participants included 10 medical doctors and final-year medical students. A qualitative study methodology using a phenomenological approach was used. Results: Meanings were formulated from transcriptions and themes were identified. The following themes emerged: emotional reactions; which included anger; helplessness; guilt and pain; recurrent thoughts about the incident; blame; perceived incompetence; detachment from emotions; religion; death of a paediatric patient; medical training; psychological services; work environment; coping with the family of the deceased; and facing mortality. Conclusion: From the study it was concluded that doctors needed enhanced training in communication skills and communicating death to the patients' families. Bereavement counselling and debriefing should be available to provide them with an opportunity to share emotional responses and reflect on patients' fatality

Occupational Stress among Radiographers: Impact of Sonography Responsability

Role extension in any occupation can affect both psychosocial and biomechanical stress levels and thus; have some consequences on efficiency in service delivery. The study was aimed to determine the impact of role extension of medical radiographers into sonography. 50 self-administered questionnaires were distributed to radiographers and to sonographers (radiographers with sonography responsibility). The questionnaires included questions seeking information on the demographic profile of the radiographer and sonographer; anatomical regions of biomechanical symptoms/stress and visual analogue scale (VAS); which rated job satisfaction and anxiety levels. 96of the questionnaires were returned and analyzed statistically using SPSS 11.0 software with P 0.05 indicating level of significance. Sonographers had more prevalence of biomechanical stress symptoms than the radiographers. Job satisfaction for sonographers (58.75) was lower than that for radiographers (64.29). Anxiety level was higher among sonographers even though this was not statistically significant. Sonography responsibility on radiographers did not have any significant effect on psychosocial stress. A balance in the extended role could aid efficiency in service delivery while improving the social strength of the individual

Occupational Stress among Radiographers: the Impact of Sonography Responsibility

Role extension in any occupation can affect both psychosocial and biomechanical stress levels and thus; have some consequences on efficiency in service delivery. The study was aimed to determine the impact of role extension of medical radiographers into sonography. 50 self-administered questionnaires were distributed to radiographers and to sonographers (radiographers with sonography responsibility). The questionnaires included questions seeking information on the demographic profile of the radiographer and sonographer; anatomical regions of biomechanical symptoms/stress and visual analogue scale (VAS); which rated job satisfaction and anxiety levels. 96of the questionnaires were returned and analyzed statistically using SPSS 11.0 software with P 0.05 indicating level of significance. Sonographers had more prevalence of biomechanical stress symptoms than the radiographers. Job satisfaction for sonographers (58.75) was lower than that for radiographers (64.29). Anxiety level was higher among sonographers even though this was not statistically significant. Sonography responsibility on radiographers did not have any significant effect on psychosocial stress. A balance in the extended role could aid efficiency in service delivery while improving the social strength of the individual

The Effect of Cold and Haemorrhagic Stress on Reticulocytes in Male Albino Wistar Rats

Background: In this study; the effect of cold and haemorrhagic stressors in male albino Wistar rats will be investigated. Methods: Cold stress was induced by placing the animals in thermostatic chamber containing ice cold water (0-10oC) and well aerated. Rats were allowed to stay for 5; 10; 15 and 20 minutes before they were bled from the tail vein at 2; 4; 6; 8 and 24 hours for reticulocyte counts. For the haemorrhagic stress; 30of blood was withdrawn from the vein after which reticulocytes were counted at 2; 4; 6; 8 and 24 hours. Results: Cold and haemorrhagic stress caused increased reticulocyte counts in male albino Wistar rats. The controls were not subjected to any condition. In cold stress; the maximum percentage reticulocyte count was (at zero hour) 6.21 + 0.21while the control was 1.02 + 0.12. In the case of the haemorrhagic stressor; the percentage reticulocyte was seen to peak at the 6th hour (6.19 + 0.12) and subsequently decrease to 2.59 + 0.02. The probable causes of this rise in reticulocytes are discussed. Conclusion: In cold and haemorrhagic stress; reticulocyte count peaked at 2 and 6 hours respectively; depicting when maximum erythropoietic activity was reached in blood forming organs

Sport Related Stress Fracture of the Clavicle with Non-Union: Case Report and Review

Stress fractures are relatively uncommon sports injuries and when they do occur; are mostly found in the lower limb. Stress fractures of the clavicle are particularly rare; having been described in a number of non-sport related pathologies; such as nervous tics and post radical neck dissection. In sport; there have only been seven cases reported in the literature. We report on a clavicle stress fracture in a 47-year-old male; partaking in recreational weight lifting activities. This is the first reported case of a non-union stress fracture of the clavicle. The patient underwent an open reduction and internal fixation and made a full recovery

Workplace Peer Educators and Stress

Peer educators form an important component of company responses to HIV and AIDS. Based on interviews with peer educators working in and around a mining company in South Africa's North-West Province; the study examines the relationship between involvement in peer education and stress. The paper discusses how becoming a peer educator can be a response to the often personal stress brought about by the HIV epidemic. In addition; structural difficulties; skills deficiencies and other obstacles to effective communication with their peers can create stress. The stress that active peer education brings to individuals is discussed; particularly in regard to the embeddedness of peer educators within their communities. The need for confidentiality also magnifies stress in the case of individuals who disregard peer educators' advice. Peer educators face many stresses in managing and supporting their own lives; thus their (voluntary) work as peer educators should not be taken out of context. Using this approach; we discuss how the role of peer educator should be conceptualised and how they can be organised and supported in order that their stress be minimised and effective engagement maximised