Development of a social skills training programme to target social isolation using virtual reality technology in primary mental health care.

Introduction: People with severe mental illness often have a small or no network of friends and limited contact with their family and live social isolated lives. We developed a social skills training programme to be administered by public mental health professionals in helping those with mental illness to overcome their social isolation. Methods: The programme was developed over 3 years in close collaboration among psychologists, service users, municipal mental health professionals, mental health service researchers and a local firm providing virtual reality (VR) training. We started with the simplest available equipment, that is, a cardboard headset combined with a smartphone, then we used Oculus Quest and now Oculus Quest 2. Results: The resulting programme is comprised of eight steps from: 1) identify service user's primary and secondary goals to 8) three-month follow-up. Conclusion: Several factors made adoption and implementation of VR technology possible in a relatively short timeframe: namely, the municipality and service users were involved from the beginning of the development process, efforts were made to introduce VR to mental health professionals and allow them to reflect on its usability, solutions were low-tech and low cost, and the long-term research collaboration was established without municipal financial obligations.

Physical Work Demands of Maintenance Workers on Onshore Petroleum Facilities in Norway: An Observational Study Utilizing Wearable Sensor Technology.

OBJECTIVES: High physical work demands can cause musculoskeletal disorders and sick leave in petroleum workers. However, our knowledge of their physical work demands is scarce and based on self-report. The objective of our study is to work towards closing this knowledge gap by assessing the physical work demands of onshore petroleum maintenance workers using body-worn sensors. METHODS: A total of 46 of 69 eligible maintenance workers (37 mechanics and 9 process technicians) from three onshore petroleum facilities in Norway filled in a questionnaire and diary and wore five accelerometers and a heart rate sensor for up to six consecutive workdays. Work-related physical activity and postures were classified using rule-based modelling in a modified version of the validated Acti4 software. RESULTS: The onshore maintenance petroleum workers were working an average of 10 h a day and spent on average this time with 48% (SD = 16.5) sitting, 1% (SD = 2.8) lying down, 39% (SD = 16.2) in light physical activity, and 9% (SD = 3.8) in moderate to vigorous physical activity. During work hours while at feet, we found arm elevation ≥60° to be 11% (SD = 7.1) (68 min), and forward bending of the trunk ≥60° to be 2% (SD = 2.2) (14 min). The workers spent 2% (SD = 2.5) (12 minu) of the workhours kneeling. We observed a high inter-individual variation for all these work exposures. Moreover, 26% (12) of the workers conducted static standing for >30% of the workday, and 17% (8) spent more than half of the work hours >33% of their estimated maximal cardiovascular capacity. CONCLUSIONS: While onshore maintenance petroleum workers on average spend about half of the workday sitting or lying down, the remaining worktime is spent with a rather high duration of arm elevation and forward bending. Quite high fraction of the workers spends much of the workhours in static standing and kneeling. We see a substantial variation in these work exposures between the workers. The findings indicate a need for preventive measures in how work is organized and performed.

Perceived Causes of Work-Related Sick Leave Among Hospital Nurses in Norway: A Prepandemic Study.

Background: Although sick leave is a complex phenomenon, it is believed that there is potential for prevention at the workplace. However, little is known about this potential and what specific measures should be implemented. The purpose of the study was to identify perceived reasons to take work-related sick leave and to suggest preventive measures. The study was completed before the COVID-19 pandemic emerged, and the risk factors identified may have been amplified during the pandemic. Methods: An in-depth cross-sectional survey was conducted across a randomly selected sample of hospital nurses in Norway. The national sample comprised 1,297 nurses who participated in a survey about their sick leave during the previous 6 months. An open-ended question about perceived reasons for work-related sick leave was included to gather qualitative information. Results: Among hospital nurses, 27% of the last occurring sick leave incidents were perceived to be work-related. The most common reasons were high physical workload, high work pace, sleep problems, catching a viral or bacterial infection from patients or colleagues, and low staffing. Conclusions: Over a quarter of the last occurring sick leave incidents among Norwegian hospital nurses are potentially preventable. To retain and optimize scarce hospital nursing resources, strategies to reduce work-related sick leave may provide human and financial benefits. Preventive measures may include careful monitoring of nurses' workload and pace, optimizing work schedules to reduce the risk of sleep problems, and increasing staffing to prevent stress and work overload.

Heat tolerance during uncompensable heat stress in men and women wearing firefighter personal protective equipment.

Firefighters run a risk of heat strain during occupational tasks. The number of female firefighters has been increasing, but research relevant to this group is still scarce. We aimed to investigate whether there are any sex differences in heat tolerance or physiological responses during uncompensable heat stress while wearing firefighter personal protective equipment. Twelve female (28 ± 7 years, 66 ± 5 kg, 51.7 ± 4.7 mL kg-1 min-1) and 12 male (27 ± 7 years, 83 ± 8 kg, 58.8 ± 7.5 mL kg-1 min-1) participants performed walking (maximum of 60 min) at 6W·kg-1, 40 °C, and 14% relative humidity. No differences were observed between groups in heat tolerance, rectal temperature, heart rate, percent body mass loss, thermal sensation, and rate of perceived exertion. Thus, when personnel are selected using gender-neutral physical employment standards, sex is not an independent factor influencing heat tolerance when wearing firefighter personal protective equipment during uncompensable heat stress.

Cognitive Performance During Night Work in the Cold.

Objective: The objective of this study was to investigate how night work at low ambient temperatures affects cognitive performance (short-term memory and reaction time), skin- and core temperature, thermal comfort, sleepiness, and cortisol. We hypothesized that cognitive performance is reduced at night compared with daytime and worsened when exposed to low ambient temperatures. Method: Eleven male subjects were recruited to perform three tests in a climatic chamber at night and daytime: Night -2°C, Night 23°C and Day 23°C. Each test lasted 6 h. Cognitive performance (short-term memory and reaction time), skin- and core temperature, thermal sensation and comfort, cortisol levels and sleepiness were measured during the tests. Results: A lower mean skin temperature and corresponding lower thermal sensation were observed at Night -2°C compared to Day 23°C and Night 23°C. Night work caused increased sleepiness and lower cortisol levels, but was not affected by changes in ambient temperatures, thermal comfort, or skin temperatures. There was no effect of either day/night work nor ambient temperature on the short-term memory or reaction time test. Conclusion: Lower skin- and core temperature were observed at night when exposed to low ambient temperature (-2°C), but there was no effect on short-term memory or reaction time. Increased sleepiness and lower cortisol levels were observed at night compared to daytime and was not influenced by low ambient temperature at night. The result from this study suggests that cognitive performance (short-term memory and reaction time) is not adversely affected by night work when exposed to low ambient temperatures if adequate protective clothing is worn.

The Use of Wearable Sensor Technology to Detect Shock Impacts in Sports and Occupational Settings: A Scoping Review.

Shock impacts during activity may cause damage to the joints, muscles, bones, or inner organs. To define thresholds for tolerable impacts, there is a need for methods that can accurately monitor shock impacts in real-life settings. Therefore, the main aim of this scoping review was to present an overview of existing methods for assessments of shock impacts using wearable sensor technology within two domains: sports and occupational settings. Online databases were used to identify papers published in 2010-2020, from which we selected 34 papers that used wearable sensor technology to measure shock impacts. No studies were found on occupational settings. For the sports domain, accelerometry was the dominant type of wearable sensor technology utilized, interpreting peak acceleration as a proxy for impact. Of the included studies, 28 assessed foot strike in running, head impacts in invasion and team sports, or different forms of jump landings or plyometric movements. The included studies revealed a lack of consensus regarding sensor placement and interpretation of the results. Furthermore, the identified high proportion of validation studies support previous concerns that wearable sensors at present are inadequate as a stand-alone method for valid and accurate data on shock impacts in the field.

One-year trial of 12-hour shifts in a non-intensive care unit and an intensive care unit in a public hospital: a qualitative study of 24 nurses' experiences.

OBJECTIVES: The aim of this study was to provide recommendations to hospital owners and employee unions about developing efficient, sustainable and safe work-hour agreements. Employees at two clinics of a hospital, one a non-intensive care and the other a newborn intensive care unit (ICU), trialled 12-hour shifts on weekends for 1 year. METHODS: We systematically recorded the experiences of 24 nurses' working 12-hour shifts, 16 in the medical unit and 8 in the ICU for 1 year. All were interviewed before, during and at the end of the trial period. The interview material was recorded, transcribed to text and coded systematically. RESULTS: The experiences of working 12-hour shifts differed considerably between participants, especially those in the ICU. Their individual experiences differed in terms of health consequences, effects on their family, appreciation of extra weekends off, perceived effects on patients and perceived work task flexibility. CONCLUSIONS: The results indicate that individual preference for working 12-hour shifts is a function of own health situation, family situation, work load tolerance, degree of sleep problems, personality and other factors. If the goal is to recruit and retain nurses, nurses should be free to choose to work 12-hour shifts.

Exploring the Potential for Use of Virtual Reality Technology in the Treatment of Severe Mental Illness Among Adults in Mid-Norway: Collaborative Research Between Clinicians and Researchers.

BACKGROUND: Virtual reality (VR) technology is not currently used in the treatment of severe mental health illness in Norway. OBJECTIVE: We aimed to explore the potential of VR as a treatment for severe mental health illness in Norway, through collaborative research between clinicians and researchers. METHODS: A collaborative research team was established, comprising researchers, the manager at a district psychiatric center, and the manager of the local municipal mental health service. An all-day workshop with eight clinicians-four from specialist mental health services and four from municipal mental health services-was conducted. The clinicians watched three different VR movies and after each one, they answered predefined questions designed to reflect their immediate thoughts about VR's potential use in clinical practice. At the end of the workshop, two focus group interviews, each with four clinicians from each service level, were conducted. RESULTS: VR technology in specialist services might be a new tool for the treatment of severe mental health illness. In municipal mental health services, VR might particularly be useful in systematic social training that would otherwise take a very long time to complete. CONCLUSIONS: We found substantial potential for the use of VR in the treatment of severe mental health illness in specialist and municipal mental health services. One of the uses of VR technology with the greatest potential was helping individuals who had isolated themselves and needed training in social skills and everyday activity to enable them to have more active social lives. VR could also be used to simulate severe mental illness to provide a better understanding of how the person with severe mental illness experiences their situation.

Towards a wearable sensor system for continuous occupational cold stress assessment.

This study investigated the usefulness of continuous sensor data for improving occupational cold stress assessment. Eleven volunteer male subjects completed a 90-120-min protocol in cold environments, consisting of rest, moderate and hard work. Biomedical data were measured using a smart jacket with integrated temperature, humidity and activity sensors, in addition to a custom-made sensor belt worn around the chest. Other relevant sensor data were measured using commercially available sensors. The study aimed to improve decision support for workers in cold climates, by taking advantage of the information provided by data from the rapidly growing market of wearable sensors. Important findings were that the subjective thermal sensation did not correspond to the measured absolute skin temperature and that large differences were observed in both metabolic energy production and skin temperatures under identical exposure conditions. Temperature, humidity, activity and heart rate were found to be relevant parameters for cold stress assessment, and the locations of the sensors in the prototype jacket were adequate. The study reveals the need for cold stress assessment and indicates that a generalised approached is not sufficient to assess the stress on an individual level.

The dry-heat loss effect of melt-spun phase change material fibres.

Phase change materials (PCM) have the ability to store latent heat when they change phases, a property that gives clothing that incorporates PCM its cooling effect. This study investigated the effect of dry-heat loss (cooling) of a novel melt-spun PCM fibre on the basis of the area covered, mass, the latent heat of fusion and melting temperature, compared to a known PCM clothing product. PCM fibres with melting temperatures of 28.4 and 32.0°C and PCM packs with melting temperatures of 28.0 and 32.0°C were studied. The results showed that the PCM fibres had a larger initial peak cooling effect than that of the PCM packs. The duration of the cooling effect of PCM fibres was primarily dependent on the PCM mass and the latent heat of fusion capacity, and secondly on the covered area and melting temperature of the PCM. PRACTITIONER SUMMARY: This study investigates the cooling effect of PCM fibres on a thermal manikin. The PCM fibres had a high but short-lasting cooling effect. This study contributes to the knowledge of how the body's temperature regulation may be affected by the cooling properties of clothing that incorporates PCM.

Protective jacket enabling decision support for workers in cold climate.

The cold and harsh climate in the High North represents a threat to safety and work performance. The aim of this study was to show that sensors integrated in clothing can provide information that can improve decision support for workers in cold climate without disturbing the user. Here, a wireless demonstrator consisting of a working jacket with integrated temperature, humidity and activity sensors has been developed. Preliminary results indicate that the demonstrator can provide easy accessible information about the thermal conditions at the site of the worker and local cooling effects of extremities. The demonstrator has the ability to distinguish between activity and rest, and enables implementation of more sophisticated sensor fusion algorithms to assess work load and pre-defined activities. This information can be used in an enhanced safety perspective as an improved tool to advice outdoor work control for workers in cold climate.

Initial heat stress on subsequent responses to cold water immersion while wearing protective clothing.

INTRODUCTION: In cold water emergency situations, helicopter aircrew will enter the water with a raised body temperature due to wearing immersion suits. Prewarming has been demonstrated to accelerate core cooling during subsequent cold water immersion (CWI) when wearing swimsuits. For this study we hypothesized that wearing an immersion suit would slow the rate of cooling in subjects who were prewarmed compared to those kept in a normothermic state. METHODS: Two different groups of male subjects (age, 24.7 +/- 4.2 yr; height, 183.1 +/- 6.5 cm; weight, 86.7 +/- 15.0 kg; body fat, 16.8 +/- 3.3%) were used to gather data under two conditions: prewarming by exercise (Warm-CWI) and baseline (Base-CWI) when wearing a dry immersion suit (2.97 Clo). In Warm-CWI, seven subjects rested for 20 min and then cycled on an ergometer cycle for 20 min before immersion in water at 5 degrees C for 140 min. In Base-CWI, six subjects were directly immersed in 5 degrees C water after resting. RESULTS: Tre and Tsk were significantly higher after Warm-CWI at start of CWI, resulting in faster core cooling rate, and a drop in Tre and Tsk during the first 10 min. In the long term, the overall core cooling did not differ between Warm-CWI (0.34 +/- 0.11 degrees C x h(-1)) and Base-CWI (0.31 +/- 0.05 degrees C x h(-1)). DISCUSSION: Wearing a dry immersion suit eliminates long-term differences in core cooling between prewarmed subjects and those kept in a normothermic state. When entering cold water with a raised Tre and Tsk, different thermal responses during the first 10 min are expected, but this does not alter long-term core cooling.

Design for end-user acceptance: requirements for work clothing for fishermen in Mediterranean and northern fishing grounds.

Fishing is one of the most dangerous occupations, and as many as 24,000 fishermen around the world suffer fatal injuries or drowning at sea every year. Although fishermen in the European fishing fleet work in harsh and dangerous environments, many fishermen do not use personal protective clothing and buoyancy aids due to reduced work comfort and poor functionality. This emphasizes the importance of designing work clothing and personal protective equipment (PPE) with functionality that matches the fishermen's needs. The aim of this study was to identify the requirements for work clothing in terms of comfort, protection, and safety for fishermen operating in northern fishing grounds and in the Mediterranean. Furthermore, we investigated whether fishermen in the Mediterranean prioritize work-clothing requirements differently from fishermen in northern fishing grounds. Interviews and observations of fishermen provided us with the requirements for work clothing for fishermen. A questionnaire was then distributed to a selection of European fishermen. The study showed that fishermen operating in the Mediterranean prioritized their requirements differently from fishermen in northern fishing grounds. There was good agreement on requirements regarding work comfort. Safety requirements, such as integrated buoyancy, were ranked as less important by the Mediterranean fishermen compared to fishermen in northern fishing grounds. The results of this study provide a basis for the development of work clothing and PPE for fishermen. Work clothing and PPE that fulfil the requirements are likely to obtain end-user acceptance and thus improve safety for fishermen at sea.

Effect of ambient temperature on endurance performance while wearing cross-country skiing clothing.

This study assessed the effects of exposure to cold (-14 and -9 °C), cool (-4 and 1 °C) and moderate warm (10 and 20 °C) environments on aerobic endurance performance-related variables: maximal oxygen consumption (VO(2max)), running time to exhaustion (TTE), running economy and running speed at lactate threshold (LT). Nine male endurance athletes wearing cross-country ski racing suit performed a standard running test at six ambient temperatures in a climatic chamber with a wind speed of 5 m s(-1). The exercise protocol consisted of a 10-min warm-up period followed by four submaximal periods of 5 min at increasing intensities between 67 and 91 % of VO(2max) and finally a maximal test to exhaustion. During the time course mean skin temperature decreased significantly with reduced ambient temperatures whereas T (re) increased during all conditions. T (re) was lower at -14 °C than at -9 and 20 °C. Running economy was significantly reduced in warm compared to cool environments and was also reduced at 20 °C compared to -9 °C. Running speed at LT was significantly higher at -4 °C than at -9, 10 and 20 °C. TTE was significantly longer at -4 and 1 °C than at -14, 10 and 20 °C. No significant differences in VO(2max) were found between the various ambient conditions. The optimal aerobic endurance performance wearing a cross-country ski racing suit was found to be -4 and 1 °C, while performance was reduced under moderate warm (10 and 20 °C) and cold (-14 and -9 °C) ambient conditions.

Effect of cold conditions on manual performance while wearing petroleum industry protective clothing.

The purpose of this study was to investigate manual performance and thermal responses during low work intensity in persons wearing standard protective clothing in the petroleum industry when they were exposed to a range of temperatures (5, -5, -15 and -25℃) that are relevant to environmental conditions for petroleum industry personnel in northern regions. Twelve men participated in the study. Protective clothing was adjusted for the given cold exposure according to current practices. The subjects performed manual tests five times under each environmental condition. The manual performance test battery consisted of four different tests: tactile sensation (Semmes-Weinstein monofilaments), finger dexterity (Purdue Pegboard), hand dexterity (Complete Minnesota dexterity test) and grip strength (grip dynamometer). We found that exposure to -5℃ or colder lowered skin and body temperatures and reduced manual performance during low work intensity. In conclusion the current protective clothing at a given cold exposure is not adequate to maintain manual performance and thermal balance for petroleum workers in the high north.

Comparison of three different prehospital wrapping methods for preventing hypothermia--a crossover study in humans.

BACKGROUND: Accidental hypothermia increases mortality and morbidity in trauma patients. Various methods for insulating and wrapping hypothermic patients are used worldwide. The aim of this study was to compare the thermal insulating effects and comfort of bubble wrap, ambulance blankets / quilts, and Hibler's method, a low-cost method combining a plastic outer layer with an insulating layer. METHODS: Eight volunteers were dressed in moistened clothing, exposed to a cold and windy environment then wrapped using one of the three different insulation methods in random order on three different days. They were rested quietly on their back for 60 minutes in a cold climatic chamber. Skin temperature, rectal temperature, oxygen consumption were measured, and metabolic heat production was calculated. A questionnaire was used for a subjective evaluation of comfort, thermal sensation, and shivering. RESULTS: Skin temperature was significantly higher 15 minutes after wrapping using Hibler's method compared with wrapping with ambulance blankets / quilts or bubble wrap. There were no differences in core temperature between the three insulating methods. The subjects reported more shivering, they felt colder, were more uncomfortable, and had an increased heat production when using bubble wrap compared with the other two methods. Hibler's method was the volunteers preferred method for preventing hypothermia. Bubble wrap was the least effective insulating method, and seemed to require significantly higher heat production to compensate for increased heat loss. CONCLUSIONS: This study demonstrated that a combination of vapour tight layer and an additional dry insulating layer (Hibler's method) is the most efficient wrapping method to prevent heat loss, as shown by increased skin temperatures, lower metabolic rate and better thermal comfort. This should then be the method of choice when wrapping a wet patient at risk of developing hypothermia in prehospital environments.

Leg exercise and core cooling in an insulated immersion suit under severe environmental conditions.

INTRODUCTION: This study was conducted to examine whether the greater rate of heat production through intermittent leg exercise would offset an elevated rate of heat loss and thereby decrease the rate of core cooling during immersion in severe conditions when wearing an insulated immersion suit. METHODS: On two separate days, seven male subjects were immersed in 2 degrees C water with air temperature of -2 degreesC, wind speed of 5 m x s(-1), and waves of 30-40 cm high. Subjects wore wool underwear, flight suits, and neoprene immersion suits. They were immersed for 180 min while remaining passive (NonEx) or performing moderate leg exercise for 5 min every 20 min (LegEx). Metabolism, rectal and skin temperatures, and skin heat flux were measured. Subjective evaluation of thermal and physical comfort was obtained. RESULTS: After 180 min core cooling was less in LegEx (0.3 degrees C) compared to NonEx (0.9 degrees C). This was attributed to a 31% increase in total heat production, but there was only a 21% increase in total heat loss when performing leg exercise compared to lying still. Leg exercise also improved thermal and physical comfort. DISCUSSION: The results suggest that wearing an insulated immersion suit under extreme environmental conditions and 5 min of leg exercise every 20 min might improve heat balance, resulting in a net heat gain (10%) compared to lying still in the water. As a result, shivering intensity is reduced, core cooling rate, and thermal and physical comfort is improved. This procedure potentially provides a practically significant survival advantage at sea and also under severe conditions.

Cooling vest for improving surgeons' thermal comfort: a multidisciplinary design project.

A laparoscopic surgeon sometimes experiences heat-related discomfort even though the temperature situation is moderate. The aim of this project was to design a cooling vest using a phase change material to increase thermal comfort for the surgeon. The project focused on the design process to reveal the most important parameters for the design of a cooling vest that could be demonstrated in a clinical setting. We performed an entire design process, from problem analysis, situation observations, concept for a prototype, temperature measurements, and a final design based on clinical testing. The project was conducted by a multidisciplinary team consisting of product designers, engineers, physiologists, and surgeons. We carried out four physiological demonstrations of one surgeon's skin temperatures and heart rate during different laparoscopic procedures. A commercially available cooling vest for firemen and two proof-of-concept prototypes were tested alongside a reference operation without cooling. To aid the final design, one person went through a climate chamber test with two different set-ups of cooling elements. The final design was found to improve the conditions of our test subject. It was found that whole trunk cooling was more effective than only upper trunk cooling. A final design was proposed based on the design process and the findings in the operating room and in the laboratory. Although the experiences using the vest seemed positive, further studies on several operators and more surgical procedures are needed to determine the true benefits for the operator.

Optimizing the performance of phase-change materials in personal protective clothing systems.

Phase-change materials (PCM) can be used to reduce thermal stress and improve thermal comfort for workers wearing protective clothing. The aim of this study was to investigate the effect of PCM in protective clothing used in simulated work situations. We hypothesized that it would be possible to optimize cooling performance with a design that focuses on careful positioning of PCM, minimizing total insulation and facilitating moisture transport. Thermal stress and thermal comfort were estimated through measurement of body heat production, body temperatures, sweat production, relative humidity in clothing and subjective ratings of thermal comfort, thermal sensitivity and perception of wetness. Experiments were carried out using 2 types of PCM, the crystalline dehydrate of sodium sulphate and microcapsules in fabrics. The results of 1 field and 2 laboratory experimental series were conclusive in that reduced thermal stress and improved thermal comfort were related to the amount and distribution of PCM, reduced sweat production and adequate transport of moisture.

Safer work clothing for fishermen.

The fisherman's work environment consists of many potential risks. A study of occupational accidents in the Norwegian fishing industry in the nine-year period from 1998 to 2006 shows that more than 3/4 of the deaths were caused by loss of fishing vessel or man-overboard accidents. Furthermore, the greatest risk of drowning is found in the smallest fleet. The aim of our project was to develop safer work clothing and through this contribute to a reduction in work accidents and injuries in the fishing fleet. We considered that it is possible to produce protective work clothing that satisfies a specification of requirements covering the fishermen's needs for protection and comfort during work. An end user-centred process including twenty-three personal interviews and a questionnaire was used to clarify the fishermen's needs and wishes before detailed design and product development. We identified an overview of all the fishermen's needs for protection during work, and produced a prioritised list of functional requirements for the clothing. The results show that the clothing previously preferred by fishermen does not satisfy all the users' demands for safety, functionality and comfort. These demands have been taken into consideration when designing improved work clothing for the fishing fleet. A selected number of prototypes were developed on the basis of the established specification of requirements. The prototypes were evaluated according to the users' requirements through tests in SINTEF's Work Physiology Laboratory and on board fishing vessels. The results demonstrate that the new protective clothing satisfies the fishermen's requirements.