ABSTRACT
BACKGROUND: In Western Africa, women continue performing heavy physical work that includes carrying loads on their heads during pregnancy. Women may adapt to pregnancy related body changes by modifying their postures to perform such tasks. OBJECTIVE: The objectives of this biomechanical task analysis study were to 1) determine sagittal plane postures of the trunk and upper extremities at specific events during the task of lifting and lowering a load to be carried on the head, 2) compare postures of pregnant and non-pregnant participants, 3) evaluate risk for musculo-skeletal disorders (MSD) with the rapid entire body assessment (REBA) criteria. PARTICIPANTS: Twenty-six pregnant (26 ± 5 years, 159 ± 9 cm, 63 ± 15 kg, 25 ± 9 weeks of pregnancy) and 25 paired non-pregnant retail merchants were recruited in Porto-Novo (Benin). METHODS: Participants were recorded on video in a laboratory setting while they lifted a tray (20% body weight) from a stool to their head and then put it back down. Trunk inclination and knee, shoulder and elbow flexion angles were determined using Dartfish® software. RESULTS: The trunk was bent by more than 80° at pick-up and set-down and knees were moderately flexed, significantly less (< 11°) for pregnant women, possibly because it was harder to lift the trunk, or for stability. For all postures analysed, the majority of trials were classified as "high" risk or "very high risk" for MSD. CONCLUSIONS: Future research should investigate prevalence of MSDs in this population to confirm the results of this study.
Subject(s)
Lifting , Posture/physiology , Pregnancy/physiology , Adult , Biomechanical Phenomena , Elbow Joint/physiology , Female , Head , Humans , Knee Joint/physiology , Lifting/adverse effects , Musculoskeletal Diseases/etiology , Risk Assessment , Shoulder Joint/physiology , Torso/physiology , Young AdultSubject(s)
Contract Services/organization & administration , Interinstitutional Relations , Managed Care Programs/organization & administration , Risk Sharing, Financial/organization & administration , Capitation Fee , Contract Services/economics , Cooperative Behavior , Hospital-Physician Relations , Managed Care Programs/economics , Models, Organizational , United StatesSubject(s)
Managed Care Programs/legislation & jurisprudence , Physician Incentive Plans/legislation & jurisprudence , Physician Self-Referral/legislation & jurisprudence , California , Centers for Medicare and Medicaid Services, U.S. , Group Practice/economics , Group Practice/legislation & jurisprudence , Humans , Managed Care Programs/economics , Medicaid , Medicare , Physician Incentive Plans/economics , Salaries and Fringe Benefits/legislation & jurisprudence , Truth Disclosure , United StatesSubject(s)
Capitation Fee , Managed Care Programs/legislation & jurisprudence , Physician Incentive Plans/legislation & jurisprudence , California , Centers for Medicare and Medicaid Services, U.S. , Costs and Cost Analysis , Managed Care Programs/economics , Quality of Health Care , Risk Management , Truth Disclosure , United StatesABSTRACT
Decline in per cent occupancy of California short-term hospitals between 1969 and 1972 was due principally to an increase in bed supply that exceeded population growth. A lesser contributory cause--decline in utilization--was due entirely to decreases in length-of-stay. Analysis of data from Statewide one-week discharge surveys, carried out in 1968 and 1970, indicates the decrease in average stay was largely centered in Medicare and Medi-Cal (Medicaid) pay classes. Admissions, however, did not decrease. These declines in stay predated the introduction of special increased restrictions on access to medical care into the Medi-Cal program in April 1970. Principal results of the study indicate that in California, government supervision of payment for hospital care has operated to reduce length-of-stay, but thus far does not seem to have affected admission rates. Insofar as these results may hold for other States, they seem to implay certain conditions that may be expected to occur with an extension of National Health insurance to the general population. Chief among these is a further depression of occupancy ratios if bed supply is held constant or increases relative to population. They also imply that further substantial reduction in hospital utilization under Medicare and Medicaid must be sought in admission rates rather than length-of-stay.
