Developing the University of Tartu in Estonia into a well-networked Patient Safety Research Centre (PATSAFE): A study protocol.

Background: Patient safety (PS) is a serious global public health problem affecting all countries. Estimates show that around 10 percent of the patients are harmed during hospital care, resulting in 23 million disability-adjusted life years lost per year. Experts emphasize research advancements as a key precondition for safer care. Aim: The Patient Safety Research Centre (PATSAFE) project enhances the Institute of Clinical Medicine of the University of Tartu's (ICM-UT) research potential and capacities in PS in order to improve and strengthen knowledge and skills in methods, techniques and experience for PS research. Methods: A strategic partnership with Avedis Donabedian Research Institute in Spain, and IQ Healthcare in the Netherlands, both international leaders in PS research, enables the development of a long-lasting knowledge exchange, allowing the ICM-UT to capitalise on its current achievements and to overcome gaps in scientific excellence in the field of PS research. These twining activities will strengthen and raise the research profile of the ICM-UT academic staff and early-stage researchers (ESRs), by implementing the hands-on training on methods, techniques, and experience in PS research. The project also encourages the active participation of ESRs in PS research by increasing their soft skills, to ensure the continuity and sustainability of PS research in ICM-UT. Finally, development of the research strategy on PS contributes to the long-term sustainability of PS research in Estonia. To implement these activities, PATSAFE foresees a comprehensive strategy consisting of knowledge exchange, soft research skills capacity building, strategic planning, and strong dissemination and exploitation efforts. Expected results: As a result of the project, ICM-UT will have the capacity to carry out PS research using the appropriate methodology and the competences to apply state-of-the-art evidence-based strategies for PS research.

Epidemiological Differences Between Localized and Nonlocalized Low Back Pain.

STUDY DESIGN: A cross-sectional survey with a longitudinal follow-up. OBJECTIVES: The aim of this study was to test the hypothesis that pain, which is localized to the low back, differs epidemiologically from that which occurs simultaneously or close in time to pain at other anatomical sites SUMMARY OF BACKGROUND DATA.: Low back pain (LBP) often occurs in combination with other regional pain, with which it shares similar psychological and psychosocial risk factors. However, few previous epidemiological studies of LBP have distinguished pain that is confined to the low back from that which occurs as part of a wider distribution of pain. METHODS: We analyzed data from CUPID, a cohort study that used baseline and follow-up questionnaires to collect information about musculoskeletal pain, associated disability, and potential risk factors, in 47 occupational groups (office workers, nurses, and others) from 18 countries. RESULTS: Among 12,197 subjects at baseline, 609 (4.9%) reported localized LBP in the past month, and 3820 (31.3%) nonlocalized LBP. Nonlocalized LBP was more frequently associated with sciatica in the past month (48.1% vs. 30.0% of cases), occurred on more days in the past month and past year, was more often disabling for everyday activities (64.1% vs. 47.3% of cases), and had more frequently led to medical consultation and sickness absence from work. It was also more often persistent when participants were followed up after a mean of 14 months (65.6% vs. 54.1% of cases). In adjusted Poisson regression analyses, nonlocalized LBP was differentially associated with risk factors, particularly female sex, older age, and somatizing tendency. There were also marked differences in the relative prevalence of localized and nonlocalized LBP by occupational group. CONCLUSION: Future epidemiological studies should distinguish where possible between pain that is limited to the low back and LBP that occurs in association with pain at other anatomical locations. LEVEL OF EVIDENCE: 2.

Work-Related Psychosocial Factors and Mental Health Problems Associated with Musculoskeletal Pain in Nurses: A Cross-Sectional Study.

Background. Musculoskeletal pain is the most common cause of incapacity among nurses. This study aimed to report the prevalence of musculoskeletal pain among hospital nurses and to explore the associations of work-related psychosocial factors and mental health problems with musculoskeletal pain. Methods. A cross-sectional survey was carried out among registered nurses at Tartu University Hospital during April and May 2011. Binary logistic regression was used to assess the associations between dependent and independent variables. Results. Analysis was based on 404 nurses (45% of the hospital's nursing population). The overall prevalence of MSP was 70% in the past year and 64% in the past month. Lower back (57%) and neck (56%) were the body areas most commonly painful in the past year. Higher quantitative and emotional demands, work pace, low justice and respect in the workplace, influence on work organisation, and role conflicts were significantly associated with musculoskeletal pain among nurses (p < 0.05). All mental health problems and most strongly somatic stress symptoms were associated with musculoskeletal pain. Conclusions. Work-related psychosocial risk factors and mental health problems, especially somatic stress symptoms, have an important impact on the occurrence of musculoskeletal pain among university hospital nurses.

Descriptive Epidemiology of Somatising Tendency: Findings from the CUPID Study.

Somatising tendency, defined as a predisposition to worry about common somatic symptoms, is importantly associated with various aspects of health and health-related behaviour, including musculoskeletal pain and associated disability. To explore its epidemiological characteristics, and how it can be specified most efficiently, we analysed data from an international longitudinal study. A baseline questionnaire, which included questions from the Brief Symptom Inventory about seven common symptoms, was completed by 12,072 participants aged 20-59 from 46 occupational groups in 18 countries (response rate 70%). The seven symptoms were all mutually associated (odds ratios for pairwise associations 3.4 to 9.3), and each contributed to a measure of somatising tendency that exhibited an exposure-response relationship both with multi-site pain (prevalence rate ratios up to six), and also with sickness absence for non-musculoskeletal reasons. In most participants, the level of somatising tendency was little changed when reassessed after a mean interval of 14 months (75% having a change of 0 or 1 in their symptom count), although the specific symptoms reported at follow-up often differed from those at baseline. Somatising tendency was more common in women than men, especially at older ages, and varied markedly across the 46 occupational groups studied, with higher rates in South and Central America. It was weakly associated with smoking, but not with level of education. Our study supports the use of questions from the Brief Symptom Inventory as a method for measuring somatising tendency, and suggests that in adults of working age, it is a fairly stable trait.

Classification of neck/shoulder pain in epidemiological research: a comparison of personal and occupational characteristics, disability, and prognosis among 12,195 workers from 18 countries.

To inform case definition for neck/shoulder pain in epidemiological research, we compared levels of disability, patterns of association, and prognosis for pain that was limited to the neck or shoulders (LNSP) and more generalised musculoskeletal pain that involved the neck or shoulder(s) (GPNS). Baseline data on musculoskeletal pain, disability, and potential correlates were collected by questionnaire from 12,195 workers in 47 occupational groups (mostly office workers, nurses, and manual workers) in 18 countries (response rate = 70%). Continuing pain after a mean interval of 14 months was ascertained through a follow-up questionnaire in 9150 workers from 45 occupational groups. Associations with personal and occupational factors were assessed by Poisson regression and summarised by prevalence rate ratios (PRRs). The 1-month prevalence of GPNS at baseline was much greater than that of LNSP (35.1% vs 5.6%), and it tended to be more troublesome and disabling. Unlike LNSP, the prevalence of GPNS increased with age. Moreover, it showed significantly stronger associations with somatising tendency (PRR 1.6 vs 1.3) and poor mental health (PRR 1.3 vs 1.1); greater variation between the occupational groups studied (prevalence ranging from 0% to 67.6%) that correlated poorly with the variation in LNSP; and was more persistent at follow-up (72.1% vs 61.7%). Our findings highlight important epidemiological distinctions between subcategories of neck/shoulder pain. In future epidemiological research that bases case definitions on symptoms, it would be useful to distinguish pain that is localised to the neck or shoulder from more generalised pain that happens to involve the neck/shoulder region.

Effects of a home-exercise therapy programme on cervical and lumbar range of motion among nurses with neck and lower back pain: a quasi-experimental study.

BACKGROUND: Cervical and lumbar range of motion limitations are usually associated with musculoskeletal pain in the neck and lower back, and are a major health problem among nurses. Physical exercise has been evaluated as an effective intervention method for improving cervical and lumbar range of motion, and for preventing and reducing musculoskeletal pain. The purpose of this study was to investigate the effects of a home-exercise therapy programme on cervical and lumbar range of motion among intensive care unit nurses who had experienced mild to moderate musculoskeletal pain in the neck and or lower back during the previous six months. METHODS: A quasi-experimental study was conducted among intensive care unit nurses at Tartu University Hospital (Estonia) between May and July 2011. Thirteen nurses who had suffered musculoskeletal pain episodes in the neck and or lower back during the previous six months underwent an 8-week home-exercise therapy programme. Eleven nurses without musculoskeletal pain formed a control group. Questions from the Nordic Musculoskeletal Questionnaire and the 11-point Visual Analogue Scale were used to select potential participants for the experimental group via an assessment of the prevalence and intensity of musculoskeletal pain. Cervical range of motion and lumbar range of motion in flexion, extension, lateral flexion and (cervical range of motion only) rotation were measured with a digital goniometer. A paired t-test was used to compare the measured parameters before and after the home-exercise therapy programme. A Student's t-test was used to analyse any differences between the experimental and control groups. RESULTS: After the home-exercise therapy, there was a significant increase (p < 0.05) in cervical range of motion in flexion, extension, lateral flexion and rotation, and in lumbar range of motion in lateral flexion. Cervical range of motion in flexion was significantly higher (p < 0.01) in the experimental group compared to the control group after therapy. CONCLUSIONS: Our results suggest an 8-week intensive home-exercise therapy programme may improve cervical and lumbar range of motion among intensive care nurses. Further studies are needed to develop this simple but effective home-exercise therapy programme to help motivate nurses to perform such exercises regularly. TRIAL REGISTRATION: Current Controlled Trials ISRCTN19278735. Registered 27 November 2015.

Work-related psychosocial risk factors and mental health problems amongst nurses at a university hospital in Estonia: a cross-sectional study.

AIM: Rapid changes in the Estonian health care system have placed extra pressure on the nursing profession, but the potential impacts of psychosocial changes have not been investigated. We aimed to explore the work-related psychosocial risk factors and their relationships with mental health problems (MHPs) amongst nurses at the university hospital in Estonia. METHODS: A cross-sectional survey was undertaken amongst registered nurses at Tartu University Hospital (TUH). Psychosocial work factors and MHPs (stress, somatic symptoms, depressive symptoms and burnout) were measured using version two of the Copenhagen Psychosocial Questionnaire (COPSOQ II). Descriptive statistics and Pearson's r correlation with sequential Bonferroni correction were used to analyse the data. RESULTS: The analysis was based on 404 nurses (45% of the full-time working population of nurses). The highest mean scores recorded for the positive work-related psychosocial factors studied were meaning of work, role clarity, social relationships and mutual trust between employees. The highest scores for the negative factors studied were the demands for hiding emotions, work pace, cognitive and emotional demands. Stress and burnout showed the highest mean scores amongst the MHPs. Quantitative and emotional demands were positively related to all of the studied MHPs, while work pace and role conflicts had a positive correlation with stress and burnout. All of the studied negative psychosocial factors were significantly correlated with burnout. CONCLUSIONS: work-related psychosocial risk factors such as quantitative demands work load, emotional demands, work pace and role conflicts, had significant positive relationships with MHPS in nurses in Estonia, and may contribute to high levels of stress as well as burnout amongst nurses: .

Risk factors for musculoskeletal pain amongst nurses in Estonia: a cross-sectional study.

BACKGROUND: Routine statistics indicate a high frequency of work-related musculoskeletal disorders in Estonia. We aimed to describe the prevalence of musculoskeletal pain (MSP) amongst Estonian nurses, and to explore associations with personal characteristics and occupational risk factors. METHODS: As a part of an international investigation (the Cultural and Psychosocial Influences on Disability (CUPID) study), a cross-sectional survey was carried out amongst registered nurses at Tartu University Hospital, focusing on pain at six anatomical sites (low back, neck, shoulder, elbow, wrist/hand and knee) lasting for more than a day during the past year and past month. Associations with regional and multi-site (≥2 anatomical sites) pain were analysed by logistic regression. RESULTS: Analysis was based on 221 female nurses (response rate 57%). The overall prevalence of MSP was 84% in the past year and 69% in the past month. The prevalence of multi-site pain was 60% in the past year and 40% in the past month. Low back, neck and knee were the sites most commonly painful. Pain in the past year tended to be more frequent at older ages, and with higher emotional exhaustion, and at most sites, with poor self-rated health, and reported distress from somatic symptoms. Multi-site pain was also significantly associated with older age and tendency to somatise. CONCLUSIONS: The prevalence of MSP among Estonian nurses is high. Psychological risk factors such as somatising tendency have an important impact. However, none of the risk factors examined seems likely to explain the high frequency of work-related musculoskeletal disorders in Estonia.