The effect of work-related psychosocial stressors on musculoskeletal disorder symptoms in hospital attendants.

BACKGROUND: Psychosocial stress at work is an important issue among hospital attendants. OBJECTIVE: This study aimed to examine psychosocial stressors in the work environment and assess their impacts on WMSD symptoms among hospital attendants in Shiraz, southern Iran. METHODS: This cross-sectional study was conducted on 198 hospital attendants from Shiraz. The study data were collected using a basic demographic questionnaire, Nordic Musculoskeletal Questionnaire (NMQ), the Persian version of Effort-Reward Imbalance Questionnaire (F-ERIQ), and an individual risk assessment (Evaluación del Riesgo Individual [ERIN]). The data were entered into SPSS version 16 and analyzed using Mann-Whitney U, Chi-square, and Spearman's correlation tests. RESULTS: The prevalence of WMSD symptoms was 29.8% in the lower back, 25.3% in knees, and 20.7% in ankles/feet. Posture analysis by the ERIN technique demonstrated that 95.5% of the postures were high risk for WMSDs. F-ERIQ identified that 83.4% of the hospital attendants belonged to the "1 < ER-ratio" category. Besides, the "effort" subscale of the F-ERIQ was significantly associated with reporting of MSD symptoms in the neck, shoulders, wrists/hands, and lower back. In addition, a significant correlation was observed between effort (r = 0.367, p = 0.028), esteem (r = -0.273, p = 0.041), security (r = -0.253, p = 0.045), and over-commitment (r = 0.301, p = 0.019) and the total score of the ERIN technique. CONCLUSION: Intervention programs and coping strategies for reduction of work-related stress and, subsequently, prevention of WMSD symptoms are recommended among hospital attendants.

Validation of the EORTC QLQ-BIL21 questionnaire for measuring quality of life in patients with cholangiocarcinoma and cancer of the gallbladder.

BACKGROUND: There is no specific quality of life (QoL) measurement tool to quantify QoL in patients with biliary tract cancer. Quality of life measurement is an increasingly crucial trial end point and is now being incorporated into clinical practice. METHODS: This International Multicentre Phase IV Validation Study assessed the QLQ-BIL21 module in 172 patients with cholangiocarcinoma and 91 patients with cancer of the gallbladder. Patients completed the questionnaire at baseline pretherapy and subsequently at 2 months. Following this, the psychometric properties of reliability, validity, scale structure and responsiveness to change were analysed. RESULTS: Analysis of the QLQ-BIL21 scales showed appropriate reliability with Cronbach's α-coefficients >0.70 for all scales overall. Intraclass correlations exceeded 0.80 for all scales. Convergent validity >0.40 was demonstrated for all items within scales, and discriminant validity was confirmed with values <0.70 for all scales compared with each other. Scale scores changed in accordance with Karnofsky performance status and in response to clinical change. CONCLUSIONS: The QLQ-BIL21 is a valid tool for the assessment of QoL in patients with cholangiocarcinoma and cancer of the gallbladder.

UK Lung Cancer RCT Pilot Screening Trial: baseline findings from the screening arm provide evidence for the potential implementation of lung cancer screening.

BACKGROUND: Lung cancer screening using low-dose CT (LDCT) was shown to reduce lung cancer mortality by 20% in the National Lung Screening Trial. METHODS: The pilot UK Lung Cancer Screening (UKLS) is a randomised controlled trial of LDCT screening for lung cancer versus usual care. A population-based questionnaire was used to identify high-risk individuals. CT screen-detected nodules were managed by a pre-specified protocol. Cost effectiveness was modelled with reference to the National Lung Cancer Screening Trial mortality reduction. RESULTS: 247 354 individuals aged 50-75 years were approached; 30.7% expressed an interest, 8729 (11.5%) were eligible and 4055 were randomised, 2028 into the CT arm (1994 underwent a CT). Forty-two participants (2.1%) had confirmed lung cancer, 34 (1.7%) at baseline and 8 (0.4%) at the 12-month scan. 28/42 (66.7%) had stage I disease, 36/42 (85.7%) had stage I or II disease. 35/42 (83.3%) had surgical resection. 536 subjects had nodules greater than 50 mm(3) or 5 mm diameter and 41/536 were found to have lung cancer. One further cancer was detected by follow-up of nodules between 15 and 50 mm(3) at 12 months. The baseline estimate for the incremental cost-effectiveness ratio of once-only CT screening, under the UKLS protocol, was £8466 per quality adjusted life year gained (CI £5542 to £12 569). CONCLUSIONS: The UKLS pilot trial demonstrated that it is possible to detect lung cancer at an early stage and deliver potentially curative treatment in over 80% of cases. Health economic analysis suggests that the intervention would be cost effective-this needs to be confirmed using data on observed lung cancer mortality reduction. TRIAL REGISTRATION: ISRCTN 78513845.

Validation of the EORTC QLQ-GINET21 questionnaire for assessing quality of life of patients with gastrointestinal neuroendocrine tumours.

BACKGROUND: Quality of life is an important end point in clinical trials, yet there are few quality of life questionnaires for neuroendocrine tumours. METHODS: This international multicentre validation study assesses the QLQ-GINET21 Quality of Life Questionnaire in 253 patients with gastrointestinal neuroendocrine tumours. All patients were requested to complete two quality of life questionnaires - the EORTC Core Quality of Life questionnaire (QLQ-C30) and the QLQ-GINET21 - at baseline, and at 3 and 6 months post-baseline; the psychometric properties of the questionnaire were then analysed. RESULTS: Analysis of QLQ-GINET21 scales confirmed appropriate aggregation of the items, except for treatment-related symptoms, where weight gain showed low correlation with other questions in the scale; weight gain was therefore analysed as a single item. Internal consistency of scales using Cronbach's α coefficient was >0.7 for all parts of the QLQ-GINET21 at 6 months. Intraclass correlation was >0.85 for all scales. Discriminant validity was confirmed, with values <0.70 for all scales compared with each other.Scores changed in accordance with alterations in performance status and in response to expected clinical changes after therapies. Mean scores were similar for pancreatic and other tumours. CONCLUSION: The QLQ-GINET21 is a valid and responsive tool for assessing quality of life in the gut, pancreas and liver neuroendocrine tumours.

Diabetes or war? Incidence of and indications for limb amputation in Lebanon, 2007.

Chronic diseases such as diabetes and vascular disease are a major public health problem in Lebanon, where primary care is not well developed. This study aimed to describe the incidence and indications for limb amputation in Lebanon and identify associated factors (age, sex, level of surgery, length of hospital stay). There were 1.6 amputations per 10 000 persons. The rate of amputation was highest in southern Lebanon at 3.8 per 10 000. The most important indication for surgery was diabetes (59%). Diabetic patients were older (mean age 73 years versus 30 years), more likely to have major surgery (OR = 7.87; 95% CI: 2.83-21.9) and stay in hospital longer (RR = 4.56, 95% CI: 2.41-8.64) than patients with trauma-related amputation. Diabetes prevention, detection and management should be prioritized in any attempt to reduce the current incidence of amputation in Lebanon.

Dramatic dietary fat reduction is feasible for breast cancer patients: Results of the randomised study, WINS (UK) - stage 1.

INTRODUCTION: The influence of dietary fat on breast tumour growth(1) and, more recently, on treatment outcomes,(2,3) suggests an important role for dietary advice in the future health of breast cancer patients. The Women's Intervention Nutrition Study (UK) - Stage 1 assessed the feasibility of achieving and maintaining a ≥ 50% reduction in reported fat intake in postmenopausal, early stage breast cancer patients in the UK. METHOD: This study recruited patients in South-east England between 2000 and 2005. They were randomly allocated into two groups. Group 1 (n = 54), received specific dietary counselling to halve their reported fat intake and maintain this low fat intake. Group 2 (n = 53) received healthy eating advice only. Dietitian-led group sessions provided support for women in both groups over 2 years.(4) Validated four-day diaries were used to measure intake. Data analysis used Generalised Linear Model (GLM) for repeated measures and logistic regression. RESULTS: A significantly greater proportion of women in Group 1 reported a fat intake reduction of ≥ 50% at 3 months (p < .001) and 24 months (p < .001) than in Group 2. The size of the effect of active dietary counselling was 37% at 3 months (95%CI: 21-54%) and 35% at 24 months (95%CI: 17-53%). Mean fat intake was halved at 3 months and 24 months in Group 1 only. CONCLUSION: Demonstrating such feasibility is a key step towards defining diet's role in the secondary prevention of breast cancer.

Development of a questionnaire (EORTC module) to measure quality of life in patients with cholangiocarcinoma and gallbladder cancer, the EORTC QLQ-BIL21.

BACKGROUND: Quality of life measurement in cholangiocarcinoma and gallbladder cancer involves the assessment of patient-reported issues related to the symptoms, disease and treatment of these tumours. This study describes the development of the disease-specific quality of life (QoL) questionnaire for patients with cholangiocarcinoma and gallbladder cancer to supplement the European Organization for Research and Treatment of Cancer (EORTC)-QLQ C30 core cancer questionnaire. METHODS: Phases 1-3 of the guidelines for module development published by the EORTC were followed, with adaptations for incorporation of questions from existing modules. RESULTS: A total of 47 QoL issues (questions) were identified; 44 questions from the two related validated questionnaires, the EORTC QLQ-PAN26 (pancreatic module) and the EORTC QLQ-LMC21 (liver metastases module), two from the Functional Assessment of Cancer Therapy hepatobiliary module questionnaire in the literature search and one from healthcare professional interviews. Following phase 1 and 2 interviews with patients (n=101) and health care professionals (n=6), a 23-question provisional questionnaire was formulated. There were five questions from PAN26, 15 from LMC21 and three extra questions. In phase 3, the provisional item list was pre-tested in 52 patients in four languages and this resulted in a 21-item module. CONCLUSION: This is the only disease-specific QoL questionnaire for patients with cholangiocarcinoma and gallbladder cancer, and initial assessments show it to be accurate and acceptable to patients in reflecting QoL in these diseases.

Prospective longitudinal study of quality of life following cytoreductive surgery and intraperitoneal chemotherapy for pseudomyxoma peritonei.

BACKGROUND: Pseudomyxoma peritonei (PMP) is characterized by mucinous ascites, predominantly arising form a perforated tumour of the appendix. This study aimed to assess Health-Related Quality of Life (HRQL) in patients following cytoreductive surgery and intraperitoneal chemotherapy for PMP. METHODS: Over a one year period, 49 consecutive patients (13 male, 36 females) with a median age of 55 (range 37-81 years) were enrolled. Patients were asked to complete the European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 questionnaire prior to surgery and at one, three, six and twelve months post-operatively. RESULTS: 26 patients (53%) underwent complete cytoreduction and 20 (42%) patients had major tumour debulking. One patient died from progressive disease three months from surgery and two patients withdrew from the study within 6 months of surgery. Baseline questionnaire compliance was 100 per cent and remained high (overall 98% of eligible patients) during follow up. Grade III/IV morbidity occurred in 4 patients (9%). Patients undergoing both complete cytoreduction and major tumour debulking reported a clinically significant improvement in emotional well-being, appetite and global HRQL at 1 year following surgery. CONCLUSION: Despite the high morbidity associated with cytoreductive surgery and intraperitoneal chemotherapy, an improvement in quality of life at 1 year following the procedure was seen following both complete cytoreduction and major tumour debulking. Longer term assessment is required to demonstrate the durability of this enhancement.

Patient-initiated delay at a genitourinary medicine clinic: are there public health consequences?

OBJECTIVES: To assess the public health consequence of patients electing not to be seen within 48 hours in a genitourinary medicine (GUM) clinic. METHODS: A 3-month retrospective case notes review was carried out for 310 new and re-book patients who chose to wait for more than 48 hours to be seen. RESULTS: Altogether, 10% (310/3110) of patients opted to be seen beyond 48 h. Their median wait was 6 days including weekends and 4 days excluding weekends. Demographic details did not vary except for the male to female ratio of 1:1.7 (1:1 in patients seen within 48 h). We found that no symptomatic patients or asymptomatic contacts of those with known sexually transmitted infections (STIs) reported sex with a new partner after booking their appointment. No patient reported sex with a recently treated partner who consequently required re-treatment and none suffered a complication of a STI. In addition, there were no cases of new HIV infection in this group and the rates of STIs were similar compared with patients seen within 48 hours of contacting the unit. CONCLUSIONS: Despite 10% of patients choosing to delay attendance beyond 48 h, no adverse public health outcomes were demonstrated.

Near work, education, family history, and myopia in Greek conscripts.

AIMS: To investigate potential factors associated with the presence of myopia in a cohort of young adult men carrying out their military service in Greece. METHODS: A nested case-control study of 200 conscripts (99 myopes and 101 non-myopes). The cohort consisted of approximately 1000 conscripts in compulsory national service. All cohort members had been screened for refractive errors by Snellen visual acuity measurement at presentation to military service; individuals not achieving visual activity 6/6 underwent noncycloplaegic refraction. The study sample consisted of the first 99 myopic and 101 nonmyopic conscripts who attended the study. In-person interviews of these 200 conscripts were conducted to obtain information on family history, occupation, level of education, near-work activities, and sleeping behaviour. chi(2) and Mann-Whitney tests were used as univariate analysis methods to identify the potential factors associated with the presence of myopia. Multiple logistic regression was used to estimate the adjusted relative risk of myopia. RESULTS: Univariate analysis showed that parental family history (P<0.001), older age (P<0.001), tertiary education (P<0.001), hours of reading per day (P<0.001), hours of computer use per day (P<0.001), and higher social classes (P<0.001) were associated with myopia. Sleeping in artificial or ambient light was not associated with myopia (P=0.75). Multiple logistic regression analysis showed that older age (OR=1.25, 95% CI 1.05-1.49), tertiary education (OR=12.67, 95% CI 3.57-44.88) and parental family history (OR=3.39, 95% CI 1.56-7.36) were independently associated with myopia. CONCLUSION: In young Greek conscripts, parental family history, older age, and education level are independently associated with myopia.

Shift work, confounding and death from ischaemic heart disease.

OBJECTIVE: To investigate the relation between shift work and death from ischaemic heart disease (IHD) and evidence for confounding by social class and healthy shift worker effects. METHODS: A case-referent study nested within an industrial cohort was used. Cases (n = 635) were cohort members who died of ischaemic heart disease (ICD 410-414) during 1950-98 aged 75 or under. Referents were matched on age and year of starting work at the site and were alive at time of case's death. Shift work status was determined from historical personnel records and pre-employment weight, height, blood pressure and smoking from medical records. Social class at first employment was inferred from job titles. To overcome potential bias due to a healthy shift worker hire effect, odds ratios were calculated from survivors 10 years after hire. To control for any healthy shift worker survivor effect, they were adjusted for duration of employment and time since termination of employment. Conditional logistic regression analysis was used to estimate ORs. RESULTS: 55% of subjects had worked as shift workers. Shift workers were more likely than day workers to belong to social class IV or V. The OR for shift workers compared with day workers, after adjustment for pre-employment risk factors, duration of employment and restricted to those who survived 10 years after hire was 1.11 (90% CI 0.90 to 1.37). This reduced to 1.04 (90% CI 0.83 to 1.30) after inclusion of social class. No dose-response relation was found. CONCLUSION: No excess risk of death from IHD for shift workers was found. The potential for confounding by social class in this relatively homogeneous cohort underlines the need to consider such confounding in more heterogeneous populations.