Critical methodological considerations in recruiting and engaging non-native English speaking workers with a head injury: a Canadian perspective.

OBJECTIVE: Non-native English speaking workers with a mild work-related traumatic brain and/or head injury are a vulnerable and underrepresented population in research studies. The researchers present their experiences with recruiting and performing qualitative interviews with non-native English speaking individuals with a work-related mild traumatic brain injury, and provide recommendations on how to better include this vulnerable population in future research studies. This paper presents considerations regarding ethics, recruitment challenges, interview preparation and debriefing, sex & gender and language and cultural issues must be made when working with this vulnerable population. RESULTS: The researchers discuss critical issues and provide recommendations in recruiting and engaging with non-native English language workers including ethics, recruitment challenges, interview preparation and debriefing, sex & gender and language, and cultural considerations that must be made when working with this population. The study recommendations advise investigators to spend more time to learn about the non-native English participants in the mild wrTBI context, to be familiar with the vulnerabilities and specific circumstances that these workers experience. By increasing their awareness of the challenging facing this vulnerable population, the intention is to provide better care and treatment options through evidence-based research and practice.

A qualitative exploration of work-related head injury: vulnerability at the intersection of workers' decision making and organizational values.

BACKGROUND: Work-related head injury is a critical public health issue due to its rising prevalence; the association with profound disruption of workers' lives; and significant economic burdens in terms of medical costs and lost wages. Efforts to understand and prevent these types of injuries have largely been dominated by epidemiological research and safety science, which has focused on identifying risk at the level of the individual worker, population group, or organizational sector. Limited research has focused on the perspectives of the workers, a key stakeholder group for informing understanding of vulnerability to work-related head injury. This study explored workers' perspectives to better understand their decision-making and how and why their injuries occurred. METHODS: We conducted a qualitative study using in-depth semi-structured interviews with thirty-two adult workers who had sustained a work-related head injury. Workers were recruited from an urban clinic in central Ontario, Canada. Labour Process Theory informed the thematic analysis. RESULTS: Three hazardous work conditions were identified: insufficient training; inadequate staffing; and inattention to the physical environment. In addition, professional and organizational norms were implicated in vulnerability to head injury including putting the client before the worker and the pressure to work unsafely. The findings also highlight a complex interrelationship between workers' decision-making and professional and organizational norms that produces vulnerability to head injury, a vulnerability which oftentimes is reproduced by workers' decisions to work despite hazardous conditions. CONCLUSIONS: Our findings suggest that, beyond the need to redress the inattention to hazards in the physical environment, there is a need to address norms that influence worker decision-making to improve the safety of workers. Using Labour Process Theory highlights an important social dynamic within workplace sectors that could inform future development and implementation of multi-level and integrated public health strategies to reduce work-related head injury.

Quality of life and its relationship to the degree of illness acceptance in patients with diabetes and peripheral diabetic neuropathy.

PURPOSE: Assessment of quality of life, especially from the psychological point of view, is likely to be strongly influenced by the degree of acceptance of one's own illness and the resultant negative emotional reactions associated with the illness itself. The aim of the present study was to determine the relationship between quality of life and the degree of acceptance of illness in diabetic patients with and without peripheral diabetic neuropathy. MATERIAL AND METHODS: 59 patients with diabetes were included in the study; they consisted of patients both with and without peripheral diabetic neuropathy. The degree of acceptance of illness was assessed using the Acceptance of Illness Scale (AIS) and quality of life (HRQOL - health-related quality of life) was measured using the SF-36v2. RESULTS: Quality of life in people with diabetes was reduced and related to their levels of illness acceptance. Factors affecting illness acceptance in patients with peripheral diabetic neuropathy included feelings of being a burden to their family and friends (p < or = 0.05) and the belief that people in their company are made anxious by the patient's illness (p < or = 0.05). These patients also defined their health status as being worse than that of diabetic patients without additional disease complications. CONCLUSIONS: Quality of life and illness acceptance were found to be strongly related. In general, patients with chronic peripheral diabetic neuropathy express lower degrees of acceptance of their illness than diabetic patients without peripheral diabetic neuropathy. Their subjective assessment of health status is also significantly worse than that of diabetic patients without neuropathy.

Exposure the doctors to aggression in the workplace.

PURPOSE: To evaluate the frequency, source and type of aggression towards doctors, depending on their place of work and position. MATERIAL AND METHODS: The study was conducted among 501 doctors from the area of Podlaskie Province. To evaluate the level and type of aggression towards doctors in their workplace we used a questionnaire prepared for the needs of this study by modifying the questionnaire "The frequency and consequences of exposing nurses to workplace aggression", which had been drafted by the Institute of Labour Medicine in Lódz. The results were analysed with the application of the chi-square and the Kruskal-Wallis tests. RESULTS: The most common form of aggression was voice raising, which happened to 80% of doctors employed in inpatient medical centres and 91% doctors from outpatient centres. More than a half of the subjects have heard threats from their patients. Verbal aggression from doctors' superiors happened most often in surgery wards (48%), neurology wards (40%), admission rooms (33%). The causes of aggression most often quoted by doctors include: staff shortages (9%), stress--tiredness (9%). CONCLUSIONS: Workplace aggression towards doctors may be inflicted both by patients and colleagues. The aggression in the medical environment can take on different forms and create a threat in the workplace. Doctors working in hospital wards (psychiatry, surgery, neurology) are the ones who are the most exposed to aggression.

Nursing problems of patients with systemic sclerosis.

UNLABELLED: Systemic sclerosis (SSc) is a chronic autoimmune disease connective tissue and one of the most common collagen diseases. There are several clinical types of scleroderma which differ in their course, possible complications and prognosis. The most characteristic form SSc is limited and diffuse systemic sclerosis. The SSc is characterized by the progressive fibrosis of the skin and internal organs, leading to their failure, morphology and blood vessels disorders. PURPOSE: The aim of our work is to identify the main health problems of patients suffering from systemic sclerosis depending on its clinical form: limited systemic sclerosis (ISSc) and diffuse systemic sclerosis (dSSc); to determine the influence of disease duration on symptom intensification in patients with LSSc and dSSc. MATERIAL AND METHODS: The study group consisted of 63 patients with systemic sclerosis diagnosed according to the criteria of the American Rheumatism Association (ARA), 47 of whom had limited systemic sclerosis (ISSc) (74.6%) and 16--diffuse systemic sclerosis (dSSc) (25.4%). CONCLUSIONS: The key thing in the complex therapy is to recognize the individual care problems of the patient, to assess his ability to cope with the disease in daily life and to plan care, support, education and help of other professionals. The main aim of individual nursing care is to alleviate ailments, prevent infections, observe life-threatening conditions and to educate the patient as regards self-care and self-observation.

Detection and monitoring of cerebral hemodynamic disturbances with transcranial color-coded duplex sonography in patients after head injury.

Reduced cerebral blood flow after severe head injury results in an increased risk of ischemic brain damage. Blood flow should therefore be monitored with a simple, reliable method. Transcranial color-coded Doppler sonography (TCCS) is an accepted tool for the diagnosis of cerebral vasospasm; however, its usefulness in evaluating patients with head injury has not been proven. Cerebral blood-flow velocity in the middle, anterior, and posterior cerebral arteries was measured with a 2.5 MHz probe (Aplio SSA 770A, Toshiba, Japan) in 36 subjects with moderate or severe head injury. Serial measurements of resistance index (RI), peak-systolic, end-diastolic, and mean velocity in the middle cerebral arteries were performed 2-24 h after head trauma and in the subsequent days during hospitalization. Immediately after head trauma, increased RI values, and unusually decreased blood-flow velocity (mainly in MCA) were observed. Microcirculation disturbances were suspected because the end-diastolic velocity had substantially diminished. Changes in blood-flow parameters correlated with the clinical state, and in most cases, a poor prognosis. In some patients, blood-flow velocity increased above the normal reference limit and this implied poor prognosis. Transcranial color-coded Doppler sonography is a reliable, repeatable, and accessible tool that provides information about cerebral blood-flow disturbances and may hold diagnostic and prognostic importance.

Proton magnetic resonance spectroscopy in patients with normal pressure hydrocephalus.

The objective of this prospective study was the application of proton magnetic resonance spectroscopy (1HMRS) in patients with normal pressure hydrocephalus (NPH) to determine the metabolite profile in the white matter next to left lateral ventricle and to assess the relationship of this profile with Evan's index. The study included 26 patients with NPH. Diagnosis of NPH was confirmed by clinical symptoms such as gait disturbance, dementia or urinary incontinence and CT study with ventricular enlargement. Ratios of NAA/Cr, Cho/Cr, Lac/Cr and mI/Cr from deep white matter were measured and compared with Evan's index and diameter of the IIIrd ventricle. Patients with hydrocephalus showed decreased ratios of N-acetylaspartate (NAA)/Cr (creatine), and increased ratios of Lac(lactate)/Cr in the white matter near the left frontal horn of the lateral ventricle compared with a well-matched control group. There was no correlation between NAA/Cr, Ch/Cr, Lac/Cr, mI (myo-Inositol)/Cr and Evan's index. A significant correlation was found between Lac/Cr and third ventricle diameter. A positive correlation was noted between Cho/Cr and dementia in patients with NPH. Our preliminary results of 1 H MRS support the idea that NPH is associated with white matter ischemia. Proton MRS is a very useful tool for evaluating major changes in metabolic levels in deep white matter in NPH patients.

The education of patients with rheumatoid arthritis--the knowledge and expectation of patients-the opinions of rheumatology nurses.

Rheumatoid arthritis (RA) is a chronic, progressive, immunologically dependent, systemic diseases of connective tissue, leading to disability, cripplehood or even premature death. Helping to improve the quality of life of RA patients involves teaching them how to cope with disease-related problems of everyday life, with stress and with suffering. The aim of the presented work is to determine the following: the patients' level of knowledge about rheumatoid arthritis; their educational needs; the impact of the level of knowledge on the patients' pro-health behaviours; the knowledge of nurses and their ability to recognize patients' problems; the nurse's tasks in preparing an RA patient for self-care. The subject group consisted of patients with RA diagnosed according to The American Rheumatism Association criteria and nurses from rheumatology clinics and wards. The research method used was a survey questionnaire, which had been constructed for the purpose of the research. The research results indicate a great need of patients, especially those with early rheumatoid arthritis, for education, support and help in adaptation. At the same time, the nurses, even though they do not fully fulfil their educational role, declare a willingness to participate in organized forms of health education.

Assessment of risk for pressure ulcers using the Norton scale in nursing practice.

PURPOSE: The aim of our study was risk assessment for the development of pressure ulcers and thus defining a group of patients considered to be at risk of developing pressure ulcers. It also helped to define the role of the nurse in the early assessment of the risk for developing pressure ulcers. MATERIAL AND METHODS: Risk assessment for the development of pressure ulcers was carried out in 199 patients hospitalised in The District Hospital in Bielsk Podlaski. The research was carried out with patients admitted to The Departments of General Medicine, Infectious Diseases and Long-Term Care. Risk assessment for the development of pressure ulcers was performed with the aid of the Norton scale. CONCLUSIONS: An increased risk for the development of pressure ulcers was found in more than half of the patients examined (53.8%). Pressure sores developed in 17.6% of the patients, women being at significantly greater risk. Risk assessment for the development of pressure ulcers with the aid of one of the recommended scales facilitates the early recognition of those patients at risk of developing pressure ulcers.

The importance of the health education in life quality improvement in patients with psoriasis.

PURPOSE: The aim of the study was to determine the influence of the psoriatic patient knowledge of the disease on the quality of life. MATERIAL AND METHODS: The study was carried out in 149 patients with psoriasis. All patients answered on anonymous questionnaire, in according to Psoriasis Disability Index (PDI). RESULTS: Almost 43% patients could not show any factor which provoked their disease, 31.5% could not tell any recommendations for cure and care of the psoriatic lesions and 32.2% patients could not point out any methods to avoid psoriatic lesions spread. Almost 60% of the group admitted that their quality of life fell because of the disease. At the same time, patients who did not have enough information concerning the disease had lower quality of life index. CONCLUSIONS: The level of the disease knowledge in the patients with psoriasis influences their quality of live. Therefore it is indicated for the patiens and their families to be involved in the proper educational program.

Oscillations of cerebrovascular resistance throughout the menstrual cycle in healthy women.

OBJECTIVES: Increased concentration of endogenous estrogen during a typical menstrual cycle has been shown to correlate with augmentation of blood flow through the internal carotid arteries (ICAs), which may be related to changes in vascular resistance within the brain. In this study we investigated the effects of endogenous estrogen and progesterone on cerebrovascular impedance in young healthy women. METHODS: The blood flow in the ICA and the common (CCA) and external (ECA) carotid arteries was studied with duplex Doppler sonography. The resistance index (RI) was determined and correlated with plasma 17beta-estradiol concentration in 14 young healthy women throughout their menstrual cycle. RESULTS: The concentration of 17beta-estradiol increased in the follicular phase of the cycle and reached a peak on day 14, whereas concentration of progesterone remained low. Along with an increase in estrogen concentration, the ICA RI had decreased from its initial level on average by 9.2% on day 13 and by 6.7% on day 14 (P < 0.05). In contrast, the trend of the ECA RI was to increase during the peak of estrogen concentration. There were no significant changes in the CCA RI or in the systolic blood pressure, heart rate, hematocrit and hemoglobin concentration through the menstrual cycle. CONCLUSIONS: Estrogen-related augmentation of blood flow through the ICA is caused mainly by decreased cerebrovascular impedance, as shown by a decrease in the ICA RI. These changes in RI suggest that estrogen influences cerebral impedance mainly by altering the resistance of cerebral microvasculature.

Tympanic temperature reflects intracranial temperature changes in humans.

The purpose of the study was to identify extracranial locations in which temperature changes in humans reflect those of intracranial temperature in a reliable and repeatable way. This was achieved by subjecting 14 non-anaesthetized patients after neurosurgery to face fanning while intracranial and extracranial temperatures were continuously measured. In all patients the cranium was closed and the group included both febrile and non-febrile as well as hyperthermic and normothermic patients. The patients' faces were fanned for 20-30 min, with a small fan at an air speed of 3.25 m s(-1). This gave intracranial temperature changes measured in the subdural space ( T(sd)) that were highly and significantly correlated ( r=0.91, P<0.05, n=14) with changes in tympanic temperatures ( T(ty)). A low, statistically insignificant correlation ( r=0.40, P>0.05, n=12) was found between T(sd) and oesophageal temperatures. In conclusion, intracranial temperature changes, induced by face fanning, were reliably reflected by the changes in T(ty).

Adaptation to night shifts and synchronisation processes of night workers.

Human beings are accustomed to being active and awake during the day, and asleep and rest at night. Since we live in a society which is organised predominantly along daytime activity, therefore working in the night shift may deeply disrupt our social and family life. It is also a well-known fact that night shift causes fatigue and circadian disruption. The basic manifestation of fatigue and circadian rhythm has been linked to health and safety problems, involving decrements in psychophysical and physiological functions, plus subjective complaints. In this context quantitative relationships between shift work and circadian rhythm need to be assessed to explore suitable time schedule, and to minimise sleep depth and fatigue. There is also a great need to discuss circadian disruption, sleepiness and the increasing cost of work related illness among night workers. In this regard, some aspects of fatigue and circadian disruption caused from night shift work are revealed in this paper aiming to increase workers' health, safety and well being as well as productivity. Light/dark cycle and social stimuli issues acting on the circadian timing systems are also explored to solicit opinions and discussion on the controversy of night work. Suggestions are therefore likewise given to enhance workers' adaptation to night shift and synchronization process.

Ergonomics of living environment for the people with special needs.

A safe, convenient, sound and healthy living environment is the prerequisite for a good house for the people with special needs. The intention of making a house in such a way that it solves basic problems of fixture and fittings. However the construction phase of a good house is a critical to design inside and outside structures. Often the builders do not know all the factors to be considered that can maintain a safe, hygienic and healthy environment. It is believed that when housing is ergonomically furnished, then a maximum benefit will be achieved. To meet with an individual's specific needs, an analysis of user's requirement is the most important factors to be considered in the design of special houses. Users' data such as anthropometric dimension, users' choices and preferences are also necessary to design a suitable living environment. In this regard, this paper illustrates some ergonomic features to design and develop good houses in terms of how people with restricted mobility and communication can truly be helped residing in their homes and performing their daily living activities. Users' social, medical and engineering needs are highlighted following the process of disability, ageing, or impairments to achieve the maximum level of benefits, and ensuring safe and sound living.

HFs/ergonomics of assistive technology.

An assistive device is designed to accommodate the special needs of disability that can help people with physical, mental or cognitive challenges go through their day-to-day activities with less difficulty. An assistive device usually provide alternatives to functional limitations imposed by the client's disorder, and thereby minimising rehabilitation costs. It is therefore important to know about how assistive technology will function in all the possible aspects of such disabilities and impairements. When designing a technical device, particularly in conjunction with the target user group, ergonomic issues are therefore important to find out the extent to which an assistive device is convenient or not, and to check the quality performance of assistive technology. Since the question of the match or mismatch of an assistive device and a disabled person requires much attention, it is therefore suggested that paying attention on how an assistive device be ergonomically designed and developed is important. Ergonomic applications are to be applied for increasing motivation of prospective customers through innovative performance of AT. The authors believe that there are opportunities in ergonomic applications to manufacture an assistive device as unique, cost saving, and allows less exertation and reduces energy consumption when it is used. Hence this paper highlights human factors and/or ergonomics consideration in the process of design and development of assistive devices synchronising with gerontechnological research and development aiming to emphasise user's requirement.

Human brain temperature in vivo: lack of heating during color transcranial Doppler ultrasonography.

This study was undertaken to assess the effect of ultrasound on human brain temperature in vivo. The investigation consisted of direct recording of intracranial temperature during color transcranial Doppler (TCD) sonography in a neurosurgical patient. The temperature was recorded from 3 thermocouples. One was implanted together with an intracranial pressure sensor into a surgically reduced intraparenchymal hematoma, the second was placed within the subdural space close to the temporal acoustic window, and the third was located extracranially at the outer surface of the temporal bone. Tympanic temperatures were also measured to give an approximation of global brain temperature. A 2.5-MHz transducer was used, and the system settings were as follows: spatial peak temporal average intensity = 234 mW/cm2 in B-mode at a maximum power of 32.3 mW and 2132 mW/cm2 in Doppler mode at a maximum power of 149.3 mW. Neither increase in the intraparenchymal brain temperature nor increase in the temperature at the bone/soft tissue interface was observed during 30 minutes of insonation. The ipsilateral tympanic temperature increased by only 0.06 degree C, and this value may be regarded as a measure of the overall increase in brain temperature. Passive cooling effect produced by the transducer, which was at ambient temperature, was found to reach the brain surface and to surpass any possible heating caused by the ultrasound. The results indicate that no noticeable increases in human brain temperature occur in response to ultrasound emitted by a color TCD device at high transmitter power settings within the diagnostic range.

Effect of endogenous estrogen on blood flow through carotid arteries.

BACKGROUND AND PURPOSE: Recent evidence suggests that physiological changes in the concentration of endogenous estrogens may influence stroke outcome. The purpose of this study was to determine a menstrual cycle-related profile of blood flow through the carotid arteries and its correlation with estrogen concentration. METHODS: The flow velocity and cross-sectional area of the common carotid artery, internal carotid artery (ICA), and external carotid artery (ECA) were measured with duplex Doppler sonography throughout the menstrual cycle in 14 healthy women. Concentration of plasma 17beta-estradiol, progesterone, hematocrit, hemoglobin, and blood pressure were also determined. RESULTS: In the follicular phase, the concentration of estrogen increased to reach a peak on day 14, whereas concentration of progesterone remained low. The mean and end-diastolic velocities in the ICA increased on average by 15% of their base values, along with increasing concentrations of estrogen (r=0.59 and 0.65, respectively). The profile of flow velocity changes in this artery corresponded to the profile of estrogen concentration. In contrast to the ICA, flow velocities in the ECA decreased from their base value, reaching their minimum in the luteal phase. The mean flow velocity in the common carotid artery increased on day 14 by just 2% of its base value. The lumen of the carotid arteries was stable throughout the cycle. Hematocrit, hemoglobin, and systolic blood pressure also remained unchanged. CONCLUSIONS: Increased concentration of endogenous estrogen correlates with substantial augmentation of flow in the internal carotid artery. This promotion of flow is caused mainly by decreased cerebrovascular resistance with consequent "stealing" of blood from the ECA.

[Magnetic resonance proton spectroscopy in neurooncology--preliminary report]. / Spektroskopia protonowa rezonansu magnetycznego w neuroonkologii--doswiadczenia wstepne.

UNLABELLED: MR proton spectroscopy (1H MRS) has been widely applied in characterisation and differentiation of brain tumors, staging, recurrence of pathologic process, post radiotherapy changes and other lesions mimicking neoplasm like abscesses. Despite of many studies performed over last 3 years in many countries spectroscopic pattern (phenotype) of brain tumors is still not well estimated and the role of each metabolite as an indicator of histopathologic grade and type of the tumor is still unknown. MATERIALS AND METHODS: In vivo 1H MR spectroscopy was prospectively performed in 36 patients with intracranial tumors (low grade gliomas, high grade gliomas, meningiomas and abscesses). Examinations was performed with 1.5 T system, using voxels of 8 cc. RESULTS: In high grade gliomas level of NAA was decreased, and consequently low ratios of NAA to other metabolites were obtained; lactate and choline peaks were markedly increased. In patients with meningiomas signal of NAA was reduced, while in abscesses group peaks of acetate and succinate were observed. Authors analysed ratios of metabolites in above-mentioned tumors. The method is especially useful in differential diagnosis in neoplastic and nonneoplastic cases. CONCLUSIONS: Our study confirms diagnostic value of 1H MRS in doubtful cases of intracranial tumors.

MIB-I as a proliferative activity marker of the multiform glioblastomas.

MIB-I is a proliferative activity marker of multiform glioblastomas which are the most frequent tumors of the central nervous system. They are characterizad by differential rate and prognosis. The aim of the study was to determine the proliferative activity of multiform glioblastomas and estimation of the correlation between tumors' proliferative activity and tumors' localization, size, patients' age and sex. 24 patients (18 females and 6 males) with multiform glioblastomas were analyzed. The mean patients' age was 52.1. The proliferative activity was calculated as a proliferation index: IP for MIB-I. Cells with positive reaction were determined by MIB-I which was compared to all neoplastic cells. The most frequent localization of the tumors were frontal and temporal lobes of the brain. The size of the tumors ranged from 2.5 to 5.3 cm (mean 3.9). Mean IP was 43.2 (SD+/-17.4). We found no correlation between IP MIB-I and localization of the tumor, patients' age and sex. There was a marginal statistically significant correlation between IP MIB-I and size of the tumor (p=0.005).

[Brain temperature in patients with central nervous system lesions]. / Temperatura mózgu u chorych operowanych z powodu uszkodzen osrodkowego ukladu nerwowego.

The knowledge of human brain temperature is still very limited. In this report we investigated the relationship between brain and trunk temperature in neurosurgical patients during normothermia and fever. Another problem addressed was that of possible gradients of temperature within the brain. We carried out direct recordings of temperature in 63 operated, neurosurgical patients with a variety of intracranial pathologies. Flexible, teflon-coated thermocouples were placed intracranially during neurosurgical procedures. Oesophageal, rectal and tympanic temperatures were also monitored. An error of up to 1.3 degrees C is to be expected in single cases if brain temperature is deduced from the rectal or oesophageal temperature. Mean differences between brain temperature and core body temperature measured in the rectum or in the oesophagus, were between 0 to 0.3 degree C. Tympanic temperature (Tty) improved the approximation of brain temperature (Tbr) to within the mean difference between Tbr-Tty close to 0 degree C. Nevertheless Tty also differed from Tbr by as much as 1 degree C in single cases. Brain temperature was the highest body temperature measured, either in normothermia or in fever. Temperature gradients were proved to exist between the warmer brain interior and cooler surface, with maximal differences in temperature reaching 0.6 degree C. This temperature gradient tended to increase along with the rise in intracranial pressure and deterioration of the level of consciousness. Our results suggest that conclusions regarding brain temperature drawn on the basis of other core temperatures, may lead to significant errors, and intracranial temperature measurement is desirable in neurosurgical intensive care. Temperature gradients within the brain may exacerbate its biochemical injury during ischaemia and fever--a combination seen frequently in neurosurgical patients. This may be particularly so, since brain temperature in fever is the highest body temperature in a high proportion of these patients.