Work related characteristics of back and neck pain among employees of a Swiss University Hospital.

OBJECTIVES: 1) To explore the staff- and work-related risk factors for spinal pain among hospital employees, 2) to investigate the effect of staff- and work-related variables on the consequences of spinal pain, such as doctor visits and sick leave. METHODS: A mailed survey was carried out in a random sample of 2700 employees stratified for occupational categories (administration staff, nurses, nurse assistants, physicians, support staff and allied health professionals). The questionnaire measured self-reported spinal pain, consequences of pain, and work characteristics. RESULTS: The response rate was 48.1% (1298/2700). The one-year prevalence of spinal pain was 67.3%, highest among nurses (75.6%) and lowest among support staff (54.9%). Reported work characteristics associated with spinal pain included frequent work at a poorly adapted work station (odds ratio (OR) 1.90 [1.24-2.93]) and having to maintain a position for a long time (OR 1.71 [1.25-2.34]). No significant correlations were observed with lifting, patient handling, material handling, or working on nightshift. Sickness leave due to spinal pain was significantly associated with duration of pain episode (OR 4.08 for>3 months compared to less than 10 days), and with work categories (OR 2.58 for nurse assistants compared to nurses). CONCLUSION: In this population of hospital employees, being a nurse, working at a poorly adapted work place, and having to maintain positions for a long time were related independently to spinal pain. Nurse assistants had a higher risk of work absenteeism.

Factors influencing emergency delays in acute stroke management.

OBJECTIVE: Early admission to hospital with minimum delay is a prerequisite for successful management of acute stroke. We sought to determine our local pre- and in-hospital factors influencing this delay. PATIENTS AND METHODS: Time from onset of symptoms to admission (admission time) was prospectively documented during a 6-month period (December 2004 to May 2005) in patients consecutively admitted for an acute focal neurological deficit presented at arrival and of presumed vascular origin. Mode of transportation, patient's knowledge and correct recognition of stroke symptoms were assessed. Physicians contacted by the patients or their relatives were interviewed. The influence of referral patterns on in-hospital delays was further evaluated. RESULTS: Overall, 331 patients were included, 249 had an ischaemic and 37 a haemorrhagic stroke. Forty-five patients had a TIA with neurological symptoms subsiding within the first hours after admission. Median admission time was 3 hours 20 minutes. Transportation by ambulance significantly shortened admission delays in comparison with the patient's own means (HR 2.4, 95% CI 1.6-3.7). The only other factor associated with reduced delays was awareness of stroke (HR 1.9, 95% CI 1.3-2.9). Early in-hospital delays, specifically time to request CT-scan and time to call the neurologist, were shorter when the patient was referred by his family or to a lesser extent by an emergency physician than by the family physician (p < 0.04 and p < 0.01, respectively) and were shorter when he was transported by ambulance than by his own means (p < 0.01). CONCLUSIONS: Transportation by ambulance and referral by the patient or family significantly improved admission delays and early in-hospital management. Correct recognition of stroke symptoms further contributed to significant shortening of admission time. Educational programmes should take these findings into account.

Does dementia predict adverse hospitalization outcomes? A prospective study in aged inpatients.

BACKGROUND: Dementia is often considered a predictor of adverse hospitalization outcomes. However, the relative contributions of dementia and other risk factors remain unclear. OBJECTIVE: To assess, in a prospective study, the relative value of dementia for predicting hospitalization outcomes, taking into account comorbidity, functional and nutritional status in 435 inpatients (age 85.3 +/- 6.7; 207 cognitively normal, 48 with mild cognitive impairment and 180 demented) from the acute and rehabilitation geriatric hospital of Geneva. Hospitalization outcomes (death in hospital, length of stay, institutionalisation and formal home care needs) were predicted using logistic regression models with sociodemographic characteristics, cognitive status, comorbid Charlson index-CCI, functional and nutritional status as independent variables. RESULTS: Moderate and severe dementia and poor physical function strongly predicted longer hospital stay, institutionalization and greater home care needs in univariate analyses. CCI was the best single predictor, with a four-fold difference in mortality rates between the highest and lowest scores. In multivariate analysis, the best predictor of institutionalisation was dementia, whereas the best predictor of death in hospital or longer hospital stay was higher comorbidity score, regardless of cognitive status. Functional status was the best predictor of greater home care needs. CONCLUSIONS: Dementia in very old medically ill inpatients was predictive only of discharge to a nursing home. Higher levels of comorbidity and poor functional status were more predictive than dementia for the other three hospitalization outcomes. Thus, comorbid medical conditions, functional and nutritional status should be considered, together with cognitive assessment, when predicting hospitalization outcome.

[Aesthetic care for old patients included in an hospital programme rehabilitation]. / Soins esthétiques aux personnes agées dans la réhabilitation hospitalière.

When old people suffering from chronic diseases are hospitalized, they need some wellness as younger people. Anxiety and depression associated to the hospitalisation and the disease are very lound. The need for any attention, touch and encouragement is sometimes not clearly expressed among the elderly, Aesthetic care may valorise old patients as healthy people. This has not been reported. Our study has evaluated 47 voluntary old women. Mini mental state was considered. They had one aesthetic care during their hospitalisation. The care evaluation's questionnaire proved the wellness feeling however the desire to open themselves to others was not significant. The depression, health state scales could not be influenced by only one such a care. Aesthetic care was generally very well accepted by the institution and health care professionals as a tool for hospital quality of life.

Gait variability while dual-tasking: fall predictor in older inpatients?

BACKGROUND AND AIMS: Increased gait variability is associated with a high risk of falling in older community-dwellers, but no information exists about the relationship between increased gait variability and falls occurring in older hospitalized patients. We therefore sought to determine, in an acute geriatric setting, whether gait variability in single- (i.e., usual walking) or dual-task conditions can predict inpatient falls. METHODS: Stride time variability was calculated in both single-task (i.e., usual walking) and dual-task conditions with a GAITRite-System in 13 male and 44 female patients (mean age=85.0, SD=6.6 yrs) consecutively admitted to the acute care geriatric department of Geneva University Hospitals, Switzerland. All participants were able to walk without assistive devices at day 3 post-admission. Falls during hospital stay were identified through the hospital accident reporting system. RESULTS: Ten fallers and 47 non-fallers were identified. The first fall events were significantly associated with the coefficient of variation of stride time in both walking conditions during hospital stay (OR 13.3, (95% CI 1.6-113.6), p=0.018 for usual walking; OR 8.6, (95% CI 1.9-39.6), p=0.006 for dual- task walking). Furthermore, the time elapsing between the first day of hospitalization and the first fall was significantly shorter when the cut-off value of stride time variability was calculated for dual-tasking compared with usual walking. The Cox regression model revealed that only the coefficient of variation of stride time during dual-task walking was significantly associated with the occurrence of the first fall event (p=0.006). CONCLUSION: Our results suggest that the degree of stride time variability in dual-task walking conditions distinguished fallers from non-fallers in a group of independently walking, older inpatients.

Concurrent validity of SMTEC footswitches system for the measurement of temporal gait parameters.

The GAITRite system is a validated portable gait analysis system that allows simple objective gait measurements. The limited length of the active area of the GAITRite system may be a limitation in obtaining reliable measures of stride-to-stride variability. In contrast, the SMTEC footswitches system provides a continuous measurement of temporal step parameters for a long distance and a long period (around 24 h). The aim of the study was to examine the concurrent validity of the SMTEC footswitches system with the GAITRite system for the measurement of temporal steps parameters. Step, stride, swing and stance time were simultaneously recorded using SMTEC and GAITRite systems while walking at normal, slow and fast self-selected walking speed among 13 healthy young adults. The level of agreement between both systems was high as for the stride time with intra-class correlation coefficients (ICC) between 0.95 and 0.99 (P<0.001) and repeatability coefficients (RC) between 1.1% and 1.5% of mean values, whereas the lowest level of agreement was shown at fast self-selected walking speed and for stance time (ICC=0.52 with P<0.001 and RC=4.9%). Furthermore, the measurement of individual footstep data was excellent with an agreement ranging between -0.04 and 0.04 s (Pitman's test of difference in variance: r=-0.009, P=0.772). The present results suggest that the SMTEC footswitches system provides a valid and reliable measurement of temporal gait parameters in healthy young adults.

Demented versus non-demented very old inpatients: the same comorbidities but poorer functional and nutritional status.

BACKGROUND: demented patients have been reported to be healthier than other old people of the same age. OBJECTIVES: to assess comorbid conditions, functional and nutritional status in medically ill hospitalised patients with normal cognition or affected by dementia of various causes and severities, or mild cognitive impairment (MCI). DESIGN AND SETTING: a prospective study was carried out, between January and December 2004, in the Rehabilitation and Geriatric Hospital (HOGER). METHODS: activities of daily living (ADL), instrumental activities of daily living (IADL) and mini nutritional assessment (MNA) scores were assessed as a function of the status of the patient two weeks before admission to hospital. On admission, cognitive status was assessed by a systematic battery of neuropsychological tests, comorbid conditions were assessed with the Charlson comorbidity index (CCI), and body mass index (BMI) and functional independence measure (FIM) were determined. BMI and FIM were also determined on discharge. RESULTS: we studied 349 patients (mean age 85.2 +/- 6.7; 76% women): 161 (46.1%) cognitively normal, 37 (10.6%) with MCI and 151 (43.3%) demented (61 Alzheimer's disease (AD), 62 mixed dementia (MD) and 17 vascular dementia (VaD)). ADL, IADL, FIM and MNA scores on admission decreased with cognitive status, regardless of the type of dementia. Functionality at discharge remained significantly lower in demented patients than in other patients. CCI was high and similar in all three groups (mean 4.6 +/- 2.7). Patients with VaD had poorer health than other demented patients, with a higher average comorbidity score, more frequent hypertension, stroke and hyperlipidaemia. Comorbidity did not increase with severity levels of dementia. CONCLUSIONS: in this cohort of very old inpatients, demented patients, non-demented patients and patients with MCI had similar levels of comorbidity, but demented patients had a poorer functional and nutritional status.

A first evaluation of an educational program for health care providers in a long-term care facility to prevent foot complications.

Patients with diabetes and chronic neurological disorders are most commonly "at-risk" with foot problems. The identification of that population is therefore mandatory to prevent severe foot lesions. However, not all health care providers (HCPs) are involved in the screening process in institutions. The authors' aim was to develop and evaluate an educational program for HCP in the field of at-risk foot. All HCPs of the Loëx Hospital (Department of Rehabilitation and Geriatrics, University Hospitals of Geneva) participated in a longitudinal prospective study. Different professions of HCP (doctors, nurses, nursing aides, physiotherapists, occupational therapists, speech-language therapists, and psychologists) attended a structured educational program during a 1-year period based on a specific consultation that the authors developed. During the sessions, risk factors and therapeutic and preventive interventions are discussed with both the patient and care givers. A questionnaire was developed and used to evaluate (1) initial knowledge of HCP in the field of at-risk foot and (2) the impact of the program on the knowledge of HCP 12 months after starting the program. Twelve months after initiating the program, a significant knowledge improvement was noted in all groups of HCP except medical doctors. Nurses presented the most significant rise in knowledge score (P < .001). In conclusion, the consultation is an acceptable and effective form of long-term educational program for HCP in a hospital setting with a huge majority of patients suffering from chronic vascular and neurological conditions and loss of protective pain sensation at the lower limb.

[Healthy elderly drivers are more likely to commit errors or lapses than violations. Survey of 904 volunteers]. / Les conducteurs âgés en bonne santé font plus d'erreurs et d'oublis que d'infractions. Enquête auprès de 904 volontaires.

OBJECTIVES: Driving is an important part of everyday life for the elderly today. Older drivers are suspected to be involved in more automobile accidents than younger adults. Although healthcare professionals are aware of specific diseases and impairments that increase accident risks, they cannot distinguish safe from unsafe drivers among the healthy elderly population in general practice. Previous English studies of younger populations differentiate three main types of bad driving that are associated with accident involvement: violations, errors, and lapses. The aim of this study was to assess the driving behavior associated with car crashes in a healthy elderly population. METHOD: This prospective survey of healthy drivers aged 65 years or older living in the community asked subjects about their habitual driving and accident history in the past three years. Subjects also completed the French version of the Manchester Aging Driver Questionnaire, which contains 24 items, scored from 0 (never) to 5 (nearly all the time) and yields three sub-scales: errors, violations, and lapses. Simple logistic regression, adjusted for age and sex, was used to analyze associations between the questionnaire results and driving history. RESULTS: These elderly drivers (mean age: 69 years) reported primarily lapses (mean: 5.42) but also violations (mean: 3.76) and errors (mean: 2.12). In all, 237 drivers (27%) reported accidents: 29.4% of the men compared with 20.2% of the women (p<0.01). After adjustment for age and gender, the logistic regression showed four specific errors and one lapse to be associated with accidents: "Queuing to turn left onto main road, you pay such close attention to the main stream that you nearly hit the car in front" (OR: 1.71; 95% CI: 1.05-2.08); "On turning left, nearly hit a cyclist who has come up on your side" (OR: 1.58; 95% CI: 1.01-2.45); "Underestimate the speed of an oncoming vehicle when overtaking" (OR: 1.48; 95% CI: 1.09-2.02); "Brake too quickly on a slippery road, or steer the wrong way into a skid" (OR: 1.60; 95% CI: 1.15-2.29); and "Hit something when reversing that you had not previously seen" (OR: 1.73; 95% CI: 1.19-2.50). CONCLUSION: As previously reported, errors and lapses are more common than violations among healthy elderly drivers. Five specific actions were associated with accident risk. The ADQ is a short, simple survey questionnaire that is useful for screening bad driving behavior in elderly drivers and for promoting safe driving practice among them.