Understanding hospital referrals to home health agencies.

Using resource dependency theory and transaction-cost economics theory, we examined the simultaneous effects of a vertical integration strategy and environmental complexity on home health agency (HHA) referrals by hospitals. Discharge data for calendar year 1990 from 61 Pennsylvania hospitals were analyzed. Using hospital ownership of home health agencies and urban versus rural location as the primary independent variables, a logistic regression model calculated the probability of HHA referral, after controlling for long-term care beds and patient characteristics. Results showed that HHA ownership was a significant predictor of home health referrals for both rural and urban hospitals, although the effect was greater for urban hospitals. These results suggest that hospitals are actively using referrals to home healthcare in response to environmental pressures. As these pressures increase, hospitals will benefit from tight linkages with home health providers.

A simplified technique for determining foot progression angle in children 4 to 16 years of age.

Foot progression angle was determined in 400 normal children ranging in age from 4-16 years using a new clinically available assessment technique. Children ages 4-5 were found to have an average out-toeing of 2.8 degrees (1 STD = 6.9 degrees). The average foot progression angle increased with age to 7.3 degrees at age 16 (1 STD = 4.4 degrees). Univariate analysis of these data found that age, tibial alignment, arch index, and the ratio of body weight to body height significantly affected foot progression angle. If, for children 4-16 years of age, two standard deviations from the average of 4.2 degrees out-toeing is taken as a normal range of variance, -8 degrees (in-toeing) to +16.4 degrees (out-toeing) would be acceptable for these ages. The measurement technique is described in detail, and the normative values and age-specific results are reviewed and discussed.

Evaluation of occupational knee-joint stress using liquid crystal thermography: a case study.

This paper describes a method to detect knee stress using liquid crystal thermography and presents the results of a case study in which the system was applied to two carpet installers. The method involves placing heat-sensitive sheets of film on the knees of workers at various intervals during the work day. The thermographic sheets react to variations in heat by changing colour. The measurements are taken with the worker's knee positioned in an illuminated, enclosed box. Once the patch stabilizes, the exhibited colours are recorded with an 8 mm video camera. The colour pattern, ranging from brown to blue, provides a thermal record of what is believed to be knee stress resulting from installing carpet. The thermographic records are stored in computer memory for subsequent analysis using an AT&T TARGA 16 video board. Custom software allows computation of the area of each distinct colour pattern as a percentage of total patch size. These records provide a characterization of knee response (inflammation) resulting from the biomechanical load sustained by the knee during the carpet installation task.

Musculoskeletal discomfort in grocery express checkstand workers. An ergonomic intervention study.

An intervention study of cashiers at a large grocery store was begun in response to employee symptoms of musculoskeletal discomfort, primarily shoulder, neck, and upper back pain, after introduction of a new express checkstand. The grocery company then instituted workplace changes directed at reducing stressful postures and the discomfort in the anatomical sites of primary concern. These changes were placement of a physical barrier to reduce trunk flexion from overreaching, installation of an adjustable keyboard to reduce static shoulder stress, and education of employees about good workplace practices to reduce musculoskeletal stress and fatigue. There was a statistically significant reduction in neck, upper back, or shoulder discomfort but not arm, forearm, or wrist discomfort. There was also a significant reduction in employee use of medication and days to recovery from discomfort but not in overall number of employees with symptoms or in hours able to operate the checkstand without discomfort. We found that ergonomic interventions, directed to the anatomical site of greatest employee concern, are likely to be effective, that employees were a good source of information on the ergonomic problems and solutions in their workplace, but that the overall approach must be iterative to achieve the maximum effect.