Work-related musculoskeletal disorders (WMSDs) among nursing personnel
|
|
- Milton Cannon
- 6 years ago
- Views:
Transcription
1 Work-Relted Musculoskeletl Injuries nd Disorders Among Occuptionl nd Physicl Therpists Amy R. Drrgh, Wendy Huddleston, Phyllis King KEY WORDS ccidents, occuptionl moving nd lifting ptients musculoskeletl diseses occuptionl therpy work Occuptionl therpists re t risk of work-relted injuries (WRIs) becuse of the demnding nture of their work. However, informtion bout WRIs nd musculoskeletl disorders mong occuptionl therpists is limited. For comprison, reserch indictes tht up to 9% of physicl therpists experience work-relted musculoskeletl disorders (WMSDs) nd pin. The purpose of this study ws to gther new informtion bout the prevlence, severity, nd chrcteristics of work-relted musculoskeletl symptoms nd injuries mong occuptionl therpists nd to compre this informtion with physicl therpists in the stte of Wisconsin. Investigtors miled surveys to 3,297 rndomly selected physicl nd occuptionl therpists living in Wisconsin. Results indicted 2006 nnul incidence rte of 6.5 injuries per 00 full-time workers mong occuptionl therpists nd 6.9 injuries per 00 full-time workers mong physicl therpists, rte similr to workers employed in hevy mnufcturing. Occuptionl therpists nd physicl therpists fce similr nd significnt risks of injury nd WMSDs. Drrgh, A. R., Huddleston, W., & King, P. (2009). Work-relted musculoskeletl injuries nd disorders mong occuptionl nd physicl therpists. Americn Journl of Occuptionl Therpy, 63, Amy R. Drrgh, R, PhD, is Assistnt Professor, Division of Occuptionl Therpy, School of Allied Medicl Professions, The Ohio Stte University, Atwell Hll, 406G, 453 West 0th Avenue, Columbus, OH ; Drrgh.6@osu.edu Wendy Huddleston,, PhD, OCS, is Assistnt Professor, Deprtment of Humn Movement Sciences, University of Wisconsin Milwukee. Phyllis King, PhD,, FAA, is Associte Den/Professor, College of Helth Sciences, Deprtment of Occuptionl Therpy, University of Wisconsin Milwukee. Work-relted musculoskeletl disorders (WMSDs) mong nursing personnel re well documented (Hignett, 996). Interventions promoting sfe ptient hndling techniques mong nursing personnel hve decresed injury incidence, severity, nd cost (Collins, Wolf, Bell, & Evnoff, 2004; Engkvist, 2006; Grg & Owen, 992; Miller, Engst, Tte, & Yssi, 2006). Physicl therpists nd occuptionl therpists move nd hndle ptients differently from nursing personnel. They use ptient hndling nd trnsfer trining s wy to restore function nd improve independence. Both disciplines receive trining from their professionl curricul in self-protection while performing these techniques. Mny therpists lso receive eduction in ergonomics s prt of their cdemic trining nd serve in the role of occuptionl helth provider for other employees in their plces of work. Despite this level of trining nd expertise, evidence indictes tht these clinicins re t risk for musculoskeletl injuries ssocited with ptient hndling (Bork et l., 996; Cmpo, Weiser, Koenig, & Nordin, 2008; Cromie, Robertson, & Best, 2000; Holder et l., 999; Molumphy, Unger, Jensen, & Lopopolo, 985; Scholey & Hir, 989; West & Grdner, 200). Although evidence on injury risk in physicl therpists exists, injury prevlence nd incidence rtes mong occuptionl therpists re less well understood. Among physicl therpists, prospective cohort study (Cmpo et l., 2008) found -yer incidence of 20.7% for WMSDs in ny body region mong rndomly selected, ntionl smple of 882 physicl therpists. The study reported tht therpists who trnsferred ptients 6 to 0 times per dy hd odds of WMSDs tht were 2.4 times higher thn those of therpists who did not trnsfer ptients. Therpists who The Americn Journl of Occuptionl Therpy 35 Downloded From: on 2/0/207 Terms of Use:
2 repositioned ptients more thn 0 times per dy hd odds of low bck WMSDs tht were 2.6 times higher thn those of therpists who did not reposition ptients. Dt from the Bureu of Lbor Sttistics (BLS; 2004) reveled similr trends: In 2004, 59% of injuries to physicl therpists were cused by ptient cre ctivities. Among the respondents, 62% of physicl therpists nd 56% of physicl therpy ssistnts reported n injury to the low bck. Other studies of physicl therpists hve exmined injuries, pin, work hbits, nd the effects of WMSDs on job performnce (Bork et l., 996; Cromie et l., 2000; Cromie, Robertson, & Best, 2002; Holder et l., 999; Mierzejewski & Kumr, 997; Molumphy et l., 985; Scholey & Hir, 989; West & Grdner, 200). Holder et l. (999) reported tht s mny s 32% of physicl therpists reported sustining work-relted injury (WRI) in the pst 2 yers. Two other studies found tht between 29% nd 45% of physicl therpists reported low bck pin (Bork et l., 996; Molumphy et l., 985). Studies in Gret Britin, Cnd, nd Austrli ll reported tht 35% to 57% of therpists experienced low bck pin (Cromie et l., 2000; Mierzejewski & Kumr, 997; Scholey & Hir, 989; West & Grdner, 200). Cromie et l. (2000) discovered tht in 6 physicl therpists moved within or left the profession becuse of WMSDs (Cromie et l., 2000). Similr ptterns of injury exist for occuptionl therpy prctitioners. Alnser (2007) reported tht pproximtely 23% of occuptionl therpists nd 23% of certified occuptionl therpy ssistnts (CAs) reported WRI. Occuptionl therpists reported the low bck s the most frequently injured body prt, nd CAs reported injuries to the wrists, hnds, nd knees. Hignett (200) reported tht occuptionl therpists in cute cre identified ptient hndling s risk fctor for injury. According to the BLS (2004), ptient cre ctivities (ptient lifting in prticulr) were responsible for 00% of ll occuptionl therpist injuries where the source ws known nd where time wy from work ws recorded. Ptient lifting ccounted for 7% of injuries to occuptionl therpists, nd injuries to the trunk, including bck nd shoulder, ccounted for 75% of injuries to occuptionl therpists (BLS, 2004). Clinicl culture in occuptionl therpy nd physicl therpy prctice my ffect complince with sfe ptient hndling methods nd increse the risk of WRIs nd WMSDs. In study of physicl therpists in Austrli, sustining n injury ws seen s unlikely becuse of the knowledge, bilities, nd perceived level of fitness physicl therpist possesses; if n injury did occur, it ws seen s the fult of the therpist (Cromie et l., 2002). In qulittive study of occuptionl therpists nd CAs, Alnser (2007) reported tht occuptionl therpists with WRIs blmed themselves for the injury nd experienced nger (towrd others nd self), depression, nd occuptionl limittions. Such beliefs my interfere with therpists using equipment to protect themselves from injury. Therpists lso re less likely to seek cre, tke time off work, or file workers compenstion clim becuse of the bility to self-tret, to recognize erly symptoms of n injury, nd to ccess clinicl collegues (Wldrop, 2004). They lso my self-tret symptoms, use collegues to pply physicl gents, nd self-prescribe exercise nd tretment progrms (Glover, McGregor, Sullivn, & Hgue, 2005; Wldrop, 2004). In summry, occuptionl nd physicl therpists represent popultion t risk of musculoskeletl injury during ptient hndling tht hs the potentil to underreport nd self-tret WRIs nd work-relted disorders. The purpose of the current study ws to describe the prevlence, incidence, nd chrcteristics of work-relted musculoskeletl injuries nd disorders mong occuptionl therpists; to compre these results with referent group of physicl therpists; nd to identify the effect of injury on work prctices. Method Prticipnts Potentil prticipnts for this study included ll licensed occuptionl nd physicl therpists who resided in Wisconsin. CAs nd physicl therpy ssistnts were not included in the study. Prticipnts were rndomly selected from list of ll licensed therpists living in the stte. Using rndom number tble, reserchers selected 50% of ll occuptionl therpists nd 50% of ll physicl therpists. Therpists who were retired or who hd not prcticed in ny of the 3 yers included in the survey were excluded. In ll, the reserchers miled 3,297 surveys to,436 occuptionl therpists nd,86 physicl therpists. Physicl therpists were chosen s referent group becuse they work in similr environments nd with similr ptients to those of occuptionl therpists. Current dt were vilble bout WRIs nd work-relted disorders mong physicl therpists (Cmpo et l., 2008), nd comprison of findings from this study to published reserch cn strengthen its externl vlidity. Reserch Design A cross-sectionl design ws used for this study. The primry vribles of interest included self-reported WRIs, selfreported musculoskeletl symptoms, nd WMSDs; chrcteristics of symptoms nd disorders; re of prctice; prctice 352 My/June 2009, Volume 63, Number 3 Downloded From: on 2/0/207 Terms of Use:
3 setting; tretment of the injury; symptom or disorder; nd position or prctice chnge. Instrumenttion. We developed survey using two published instruments previously used with physicl therpists. The first, designed by Holder et l. (999), ws used to identify self-reported injuries mong physicl therpists. The second, designed by Cmpo et l. (2008), ws used to identify nd describe WMSDs. For the current study, the reserchers dpted nd combined both surveys to gther more complete picture of the experiences of the prticipnts. The literture hs identified the reporting of injury mong therpists s poor nd noted tht therpists often self-tret nd seek tretment from collegues (Wldrop, 2004). Becuse of concern tht therpists my not consider their symptoms musculoskeletl injury or disorder, the reserchers creted n instrument tht combined elements of both. The survey consisted of three prts: Section A, bsic demogrphic nd work history informtion; Section B, self-report of work-relted musculoskeletl injuries sustined in ech of the pst 3 yers (2004, 2005, 2006); nd Section C, questions bout musculoskeletl symptoms experienced the prior yer, including frequency, durtion, nd severity. Reserchers used stringent cse definition of WMSD, bsed on the work of Cmpo et l. (2008), to identify therpists who reported no injuries but who experienced pin. The definition ws designed to identify WMSDs serious enough to cuse problems t work but to void symptoms tht were minor complints. The definition identified person s hving WMSD if he or she rted pin of t lest 4 of 0 on visul nlog scle (from 0 0) tht lsted more thn week or ws present t lest once month (Cmpo et l., 2008). Prticipnts were directed to complete only Section B or C, not both. Those who reported WRI in the pst 3 yers were directed to complete Section B. Those who reported no WRIs were directed to complete Section C. The intent ws to cpture more complete informtion bout the experiences of the prticipnts with injury nd with symptoms. The survey ws developed nd piloted on five occuptionl therpists nd five physicl therpists. The survey ws then revised nd redied for dissemintion. Procedures. We miled presurvey postcrd to 3,297 potentil prticipnts in Wisconsin. One week lter, they were sent cover letter; demogrphic informtion pge; questionnire; nd stmped, self-ddressed envelope. All responses were confidentil, nd no personl identifiers were included in the survey. After 3-week witing period, the miling ws repeted. No surveys were opened until the second miling ws completed. Dt Anlysis. Incidence rtes nd prevlence were clculted for injuries in both professions. Annul injury prevlence ws clculted using the following formul: Prevlence = totl number of therpists with one or more injuries totl number of therpists exposed in the yer. Annul injury incidence rtes per 00 full-time workers for ll prticipnts nd for ech profession were clculted using the following formul (BLS, 2007): Injury incidence rte = (totl number of therpists injured per yer 200,000), totl number of hours worked per yer where 200,000 hr equls the equivlent of 00 employees working 40 hr per week, 50 weeks per yer. The totl number of therpists injured ws used in the numertor rther thn the totl number of injuries. Severl therpists reported multiple injuries within ech yer. Becuse we were unble to determine whether ech injury event ws seprte nd distinct or n ggrvtion of the originl injury, we coded the number of injuries dichotomously (not injured or injured). However, injuries reported by therpists over multiple yers were included, even if they reported n injury in ech of the 3 yers, for mximum of one injury per yer. Confidence intervls for the incidence rtes were estimted using the method described by Henszel, Lovelnd, nd Sirken (962) for dt following Poisson distribution for rre events. Bsic descriptive nlyses, independent smple t tests, Person chi squre, nd odds rtios were conducted () to describe the personl nd professionl fctors ssocited with injuries, pin nd discomfort, nd WMSDs; (2) to identify the reporting nd tretment-seeking behviors of therpists; nd (3) to describe the reltion between injury or WMSD nd work prctices. Work prctices include ptient tretment, time off from work, nd the proportion of occuptionl therpists nd physicl therpists who hve chnged prctice re becuse of symptoms or injuries. Prticipnts who reported multiple WRIs nswered the questions ccording to the injury tht most interfered with their work. Results Of the 3,297 surveys miled out, we received,89 responses; the response rte ws 36%. A totl of 3 respondents were excluded becuse they hd retired, decided to sty t home with their children, or not filled out the form completely. Missing dt were replced with the men vlue of the smple. One item, bord nd specilty certifictions, ws eliminted becuse of incomplete nd incorrect responses The Americn Journl of Occuptionl Therpy 353 Downloded From: on 2/0/207 Terms of Use:
4 (e.g., identifying Ntionl Bord for Certifiction in Occuptionl Therpy registrtion s bord certifiction). Another item, prctice re, ws modified: Acute cre nd subcute (inptient) rehbilittion were combined becuse most therpists identifying cute cre s their primry prctice re lso identified subcute rehbilittion s primry prctice re. The finl smple totled,58 nd included 477 occuptionl therpists nd 68 physicl therpists. Comprison of the Professions Bckground chrcteristics of prticipnts re presented in Tble. Occuptionl therpists nd physicl therpists were comprble in ge, body mss index (BMI), nd yers of experience. Almost ll therpists rted themselves s hving good to excellent helth (98% of occuptionl therpists nd 96% of physicl therpists). The men ge ws 43 yers, nd men BMI ws <25. Physicl therpists were more likely thn occuptionl therpists to rte their helth s excellent (n = 477 occuptionl therpists nd 68 physicl therpists for ll χ 2 ) (55% compred with 46%; χ 2 [] = 38.58, p =.000). Occuptionl therpists reported n verge of 7.4 yers of experience, nd physicl therpists reported n verge of 8 yers. A higher proportion of physicl therpists thn occuptionl therpists were mle (20%) (4.2%; χ 2 [] = 63.09, p =.000). Eductionl level differed s expected, given the eduction requirements of the disciplines. Among prticipnts, 43% of physicl therpists held grdute degrees t both the mster s nd the doctorl level, compred with 20% of occuptionl therpists (χ 2 [] = 63.72, p =.000). Occuptionl therpists nd physicl therpists worked similr number of hours per week: 33 nd 34 hr, respectively. Physicl therpists, however, spent pproximtely 2. hr per Tble. Comprison of Bckground nd Professionl Chrcteristics in Occuptionl Therpists nd Physicl Therpists (N = 58) Chrcteristic Professionl Affilition n M (SD) t df p Age (9.30) (0.5) Yers of prctice (9.04) (0.48) Body mss index (4.73) (4.08) Hours worked per week (0.90) (.7) Hours ptient cre per week (9.74) (0.48) * n Proportion Person χ 2 df p b Acdemic degree Bchelor s Mster s Doctorte * Gender Femle Mle * Helth Excellent/good Fir/poor Note. = physicl therpist; = occuptionl therpist; M = men; SD = stndrd devition. p vlues obtined through independent smples t-test nlysis. b p vlues obtined through chi-squre nlysis. *Sttisticlly significnt t p My/June 2009, Volume 63, Number 3 Downloded From: on 2/0/207 Terms of Use:
5 Figure. Prctice re by professionl ffilition, Note. N =,5; 7 therpists reported tht they did not work in Those who specified type of privte prctice were included in the pproprite re. For exmple, physicl therpists who indicted tht they worked in privte prctice for outptient orthopedics were included in Outptient Clinic. week more thn occuptionl therpists in direct ptient cre (t [55] = 3.48, p =.00). The primry prctice res differed between the professions (Figure ). The lrgest proportion of occuptionl therpists worked in peditrics (27.3%). Occuptionl therpists were twice s likely to work in peditrics s were physicl therpists. Peditrics ws followed by outptient rehbilittion, cute cre nd inptient rehbilittion, nd skilled nursing fcilities. Physicl therpists were twice s likely to work in outptient res s were occuptionl therpists. Almost hlf of physicl therpists (48.9%) identified outptient rehbilittion s their primry prctice re, followed by hospitl, peditrics, nd skilled nursing fcilities. Injury Prevlence nd Incidence Injury prevlence nd injury incidence rtes were clculted for occuptionl therpists nd physicl therpists who reported WRI (Tble 2). Therpists who reported tht they did not work during prticulr yer were not included in the clcultions for tht yer. Of the 477 occuptionl therpists who responded, 04 reported 90 injuries over 3 yers. Of the 68 physicl therpists who responded, 44 reported 279 injuries over 3 yers. Approximtely 6.7% of injured physicl therpists nd 3.5% of injured occuptionl therpists reported multiple injuries over the 3-yer period. The nnul injury prevlence for the therpists overll ws 0.2% in 2004, 0.5% in 2005, nd 3.5% in Therpists in generl experienced nnul injury incidence rtes (bsed on self-report of WRI) of 2.4 per 00 full-time workers in 2004, 2.9 per 00 full-time workers in 2005, nd 6.7 per 00 workers in Injury incidence rtes did not differ significntly between the disciplines (Tble 2). The rtes for injuries sustined in 2006, which rgubly were the most ccurtely reclled, were 6.5 per 00 full-time occuptionl therpists nd 6.9 per 00 fulltime physicl therpists. Among both professions, injuries to the low bck were reported by the gretest proportion of therpists (30% of occuptionl therpists nd 33% of physicl therpists). Injuries to the hnd (2% occuptionl therpist, 20% physicl therpist), shoulder (7% occuptionl therpist, 5% physicl therpist), neck (4% occuptionl therpist, 5% physicl therpist), nd wrist (4% occuptionl therpist, 4% physicl therpist) followed s the body regions most commonly identified s injured. Risk Fctors for Injury Investigtors exmined profession, gender, weight, ge, yers of experience, hours worked per week, nd ptient contct The Americn Journl of Occuptionl Therpy 355 Downloded From: on 2/0/207 Terms of Use:
6 Tble 2. Injury Prevlence nd Injury Incidence Rtes per 00 Full-Time Workers Among Occuptionl nd Physicl Therpists Yer Discipline N Number of Injuries Prevlence (%) Incidence 95% Confidence Intervl , , , , , , , , 5.40 Note. = physicl therpist; = occuptionl therpist. hours per week s potentil risk fctors for injury. Odds rtios were clculted for professionl ffilition, gender, BMI, nd ge (Tble 3). The results reveled no difference in the odds of injury between the professions. Within nd between ech profession, gender did not emerge s risk fctor for injury. To ssess weight s risk fctor, we converted BMI to dichotomous vrible. A BMI 25 ws considered overweight. The odds rtios did not support BMI s risk fctor for injury mong occuptionl therpists or physicl therpists. Age ws lso converted to dichotomous vrible, with older workers identified s those 55 yers or older. The odds rtios did not support ge s risk fctor for injury for occuptionl therpists or for physicl therpists. Risk exposure, mesured by hours of work nd ptient cre hours, ws ssocited with injury (Tble 4). Occuptionl therpists with injuries worked pproximtely 4 hr more per week thn those without injuries (t [475] = 3.8, p =.002). Physicl therpists who were injured worked pproximtely 2 hr more per week (t [29.9] = 2.04, p =.042). Injured occuptionl therpists spent pproximtely 2.6 more hours working directly with ptients thn those without injuries Tble 3. Odds Rtios for Fctors Associted With Injuries in Occuptionl nd Physicl Therpists 95% Confidence Intervl Fctor N Odds Rtio Lower Upper Profession, Profession Femle Mle Gender Weight Age Note. = physicl therpist; = occuptionl therpist. Odds of being n mong those with work-relted injuries, with s s referent group. (t [475] = 2.34, p =.02). Among both occuptionl therpists nd physicl therpists, experience ws not ssocited with WRI. Injury Reporting nd Tretment Behviors Another im of the study ws to evlute whether therpists tended to underreport injuries, engged in self-tretment, nd continued to work while injured (Tble 5). Results indicted tht fewer thn hlf of occuptionl therpists nd physicl therpists reported their injuries to their employers but tht the mjority of therpists sought tretment for their injuries. There ws no sttisticlly significnt difference in the proportion of mle nd femle occuptionl therpists who reported their injuries (χ 2 [] = 0.272, p =.469). Among physicl therpists, men were significntly less likely to report WRI thn women (χ 2 [] = 4.35, p =.037). Tretment vried on the bsis of whether the injury ws reported to the employer. Among therpists who reported their injuries, 9% of occuptionl therpists nd 87% of physicl therpists sought tretment. Most occuptionl therpists sought tretment from physicin or chiroprctor (7%) or treted the injury themselves (50%). A substntil proportion sought tretment from collegue (27%). Physicl therpists who reported their injuries were s likely s occuptionl therpists to seek tretment from physicin or chiroprctor (63%), occuptionl therpist or physicl therpist (37%), collegue (29%), nd to tret themselves (52%). Occuptionl therpists who reported their injury were.5 times s likely to seek tretment for the injury s those who did not report n injury (χ 2 [] =.3, p =.00), lthough mong physicl therpists, reporting behvior ws less strongly ssocited with seeking tretment (χ 2 [] = 2.98, p =.084). Therpists who did not report injuries, however, lso obtined tretment for their injuries. In fct, 30% of occuptionl therpists nd 37% of physicl therpists who did not report WRI to their employer received tretment 356 My/June 2009, Volume 63, Number 3 Downloded From: on 2/0/207 Terms of Use:
7 Tble 4. Assocition Between Bckground Chrcteristics nd Work-Relted Injury Without Injury With Injury Fctor N M (SD) M (SD) t df p Experience (yers) (9.) 8.3 (0.40) 8.3 (8.74) 6.8 (0.68) Hours worked per week (0.73) 33.7 (2.26) 35.9 (.04) 35.6 (9.26) *.042* Ptient cre hours per week (0.06) 30.7 (0.92) 30.9 (8.24) 32. (8.55) *.089 Note. = physicl therpist; = occuptionl therpist; M = men; SD = stndrd devition. p vlues obtined through independent smples, two-tiled t test. *Sttisticlly significnt t p.05. from physicin or chiroprctor nd 60% of occuptionl therpists nd 75% of physicl therpists self-treted. Effect of Injury on Work Prctices Almost ll occuptionl therpists nd physicl therpists who reported WRI stted they continued to work while they were injured (Tble 5). Most ltered their work hbits becuse of the injury nd reported tht clinicl prctice excerbted their symptoms. Few reported tht they limited ptient contct time becuse of the injury, nd only 6% of occuptionl therpists nd physicl therpists reported tht they missed hlf-dy of work or more becuse of their injuries. Approximtely 28% of the therpists either considered chnging jobs or hd chnged jobs becuse of their injuries. No sttisticlly significnt differences were found within ech profession in the proportion of mle therpists nd femle therpists on ny of these vribles. Work-Relted Musculoskeletl Symptoms nd Disorders Of the 373 occuptionl therpists who did not report WRI, 43% reported work-relted musculoskeletl symptoms (Tble 6). The nnul prevlence of symptoms mong the 537 physicl therpists who did not report n injury ws 49%. Of those who reported symptoms, totl of 53 therpists met the criteri for WMSD. The 2-month prevlence of WMSD ws 8% for occuptionl therpists nd 6% for physicl therpists. Tble 5. Work Prctices nd Culturl Fctors Among Occuptionl nd Physicl Therpists With Work-Relted Injuries Proportion Culturl Fctors nd Work Prctices Person χ 2 df p Reported injury to workplce 0.44 (44/0) 0.38 (54/42) Sought tretment 0.74 (75/0) 0.8 (5/42) MD/DC / Clinic Collegue Self-tret 0.46 (48/04) 0.30 (3/04) 0.22 (23/04) 0.54 (56/04) 0.38 (55/44) 0.23 (33/44) 0.26 (37/44) 0.66 (95/44) Missed t lest hlf-dy of work 0.30 (30/0) 0.26 (38/44) Worked while injured 0.96 (96/00) 0.95 (36/43) Altered work hbits 0.74 (74/00) 0.73 (04/43) Limited ptient contct time 0.4 (4/00) 0. (5/43) Clinicl prctice excerbtes symptoms 0.64 (63/99) 0.6 (86/4) Considered chnging jobs 0.20 (20/00) 0.2 (30/43) Chnged jobs becuse of injury 0.08 (8/00) 0.08 (2/43) Note. = physicl therpist; = occuptionl therpist; MD = medicl doctor; DC = chiroprctor. p vlues obtined through Person χ 2 test of ssocition The Americn Journl of Occuptionl Therpy 357 Downloded From: on 2/0/207 Terms of Use:
8 Tble 6. Pin nd Work-Relted Musculoskeletl Disorders (WMSDs) Prevlence nd Associted Fctors Among Occuptionl Therpists nd Physicl Therpists (n = 90) Fctor n No Pin or Discomfort Pin Prevlence WMSD Prevlence Person χ 2 (WMSD) df p (60/373) 0.8 (67/373) (264/537) 0.6 (86/537) No WMSD With WMSD Fctor (mong those with pin/discomfort) n M (SD) M (SD) t df p b Experience (yers) Hours worked/week Ptient cre hours/week (9.36) 8.45 (0.43) 3.38 (.35) (.44) (0.43) 3.65 (.39) 6.9 (9.50) 7.7 (0.26) 32.4 (0.57) 33.6 (0.73) 30. (8.39) 30.2 (9.7) 6.4 (8.24) 8.9 (0.75) 34.0 (8.62) 34.4 (7.00) 29.4 (0.67) 3.4 (.68) Note. = physicl therpist; = occuptionl therpist; M = men; SD = stndrd devition. p vlues obtined through Person χ 2 test of ssocition, comprison of proportion of WMSD mong s nd s. b p vlues obtined through independent smples, two-tiled t test, comprison of WMSD to those with no pin or discomfort. *Sttisticlly significnt t p * WMSDs of the low bck were identified by the gretest proportion of occuptionl therpists nd physicl therpists (49% occuptionl therpists, 4% physicl therpists). WMSDs of the neck (39% occuptionl therpists, 35% physicl therpists), hnd (30% occuptionl therpists, 28% physicl therpists), shoulder (27% occuptionl therpists, 24% physicl therpists), nd upper bck (22% occuptionl therpists, 28% physicl therpists) were the other body regions most often identified by therpists with WMSD. Risk Fctors for Work-Relted Musculoskeletl Symptoms nd Disorders We evluted BMI, ge, nd gender s potentil risk fctors ssocited with pin nd WMSD (Tble 7). BMI >25 ws risk fctor for WMSD mong occuptionl therpists (odds rtio [OR] = 2.47; 95% confidence intervl [CI] =.26, 4.84) but not physicl therpists. Age 55 yers lso emerged s risk fctor for WMSD mong occuptionl therpists. The odds of being 55 yers old were 3.46 times s high mong respondents with WMSD s mong those without (95% CI =.4, 0.49). Too few mle occuptionl therpists responded to evlute the effect of gender on WMSD. Among physicl therpists, the odds of being femle were.85 times s high mong those with WMSD s mong those without WMSD, lthough the confidence intervl mkes tht finding questionble (95% CI = 0.895, 3.83). The odds of being n occuptionl therpist, s opposed to physicl therpist, were.49 times s high mong those with WMSD s mong those without, nd gin the confidence intervl mkes the finding difficult to confirm (95% CI = 0.994, 2.24). Experience, work hours, nd direct ptient cre hours were lso ssessed s potentil risk fctors (Tble 6). Among occuptionl therpists, those with pin or discomfort spent more hours in ptient cre per week thn those without (t [37] = 2.434, p =.05). There were no sttisticlly significnt differences in yers of prctice or hours worked per week mong those with pin nd those without. When we evluted occuptionl therpists who met the criteri for WMSD, those with WMSDs worked pproximtely 2. hr more per week thn those without ny symptoms (t [44] = 2.007, p =.047). The hours in ptient cre did not differ between occuptionl therpists with WMSD nd occuptionl therpists without pin or discomfort. There were no sttisticlly significnt differences in the yers of experience, hours worked per week, nd ptient contct hours per week Tble 7. Odds Rtios for Fctors Associted With Work-Relted Musculoskeletl Disorders (WMSDs) in Occuptionl nd Physicl Therpists 95% Confidence Intervl Fctor N Odds Rtio Lower Upper Profession Gender b Weight Age Note. = occuptionl therpist; = physicl therpist. Odds of being n mong those with WMSD, with s referent group. b Unble to compute becuse 0 men filed to meet cse definition. 358 My/June 2009, Volume 63, Number 3 Downloded From: on 2/0/207 Terms of Use:
9 mong physicl therpists with pin nd without nd mong those who met the cse definition of WMSD nd those who did not. WMSD Reporting nd Treting Behviors According to Wldrop (2004), physicl therpists tend to underreport their symptoms; therefore, reporting behviors were ssessed for this cohort of occuptionl therpists nd physicl therpists (Tble 8). Among occuptionl therpists, 22% of those with WMSDs reported their symptoms to their employer, compred with 8% of physicl therpists with WMSDs. Occuptionl therpists with WMSDs were more likely to report their symptoms thn those with milder pin. However, this ws not true for physicl therpists. The sme proportion reported their symptoms (8%), regrdless of severity. Of note is tht 70% of occuptionl therpists with WMSDs nd 57% of physicl therpists with WMSDs sought tretment for their symptoms, even though few reported them to the employer. Although most occuptionl therpists nd physicl therpists with WMSDs self-treted (60% of occuptionl therpists nd 43% of physicl therpists), 34% of occuptionl therpists nd 22% of physicl therpists sought tretment from physicin or chiroprctor, nd mny sought tretment from more thn one professionl. WMSD Effects on Work Prctices Meeting the cse definition of WMSD ppered to be n importnt fctor in work behviors in both physicl therpists nd occuptionl therpists. Physicl therpists nd occuptionl therpists were more likely to seek tretment, see physicin, lter their work hbits, nd consider chnging jobs if they met the cse definition of WMSD (Tble 8). In fct, 25% of occuptionl therpists with WMSDs nd 35% of physicl therpists with WMSDs reported tht they were considering chnging or hd chnged jobs becuse of the WMSD. These therpists lso were more likely to report tht pin interfered with work nd tht prctice excerbted their pin or discomfort. Physicl therpists with WMSD were more likely to limit their ptient contct time becuse of their symptoms thn those without WMSD. Given these findings, it is importnt to note tht most physicl therpists nd occuptionl therpists with WMSD worked while experiencing pin or discomfort, nd very few indicted tht they missed work becuse of the WMSD. Discussion The results of this study indicte tht occuptionl therpists nd physicl therpists re t similr nd significnt risk of WRI nd of developing WMSDs. As point of comprison, the 2006 injury rte of lmost 7 per 00 full-time workers is similr to the 2006 incidence rtes for non cly refrctory mnufcturing (6.9), motor home mnufcturing (6.8), iron foundry work (5.), nd light truck mnufcturing (4.6) (BLS, 2006). The nnul prevlence of injuries, symptoms, nd WMSDs found in this study is similr to those found in other studies (Alnser, 2007; Cmpo et l., 2008; Holder et l., 999). The combined findings of these studies indicte tht work-relted injuries nd disorders mong occuptionl nd physicl therpists pose significnt popultion helth problem. Severl personl chrcteristics were ssocited with WMSD, including weight nd ge for occuptionl therpists nd being femle for physicl therpists. These fctors hve been supported by other studies (Cmpo et l., 2008). Hours worked per week nd ptient cre hours were lso ssocited with injury nd WMSD. This finding is likely the result of incresed exposure nd, potentilly, ftigue. The culture of occuptionl nd physicl therpists my be plcing therpists t risk. Similr to the findings of Wldrop (2004), fewer thn hlf of therpists in this study reported their injuries to their employers, nd <25% reported their WMSDs. The clinicl culture of helth cre providers is one in which ltruism is vlued, so dmitting n injury cused by ptient cre is difficult. Both respondents with injuries nd those with WMSDs hd symptoms tht were excerbted by clinicl prctice; they worked while in pin nd reported tht their conditions interfered with work, but few limited ptient contct time or missed work. This reluctnce to identify n injury my be why so mny therpists who indicted they hd not sustined ny WRIs described musculoskeletl symptoms severe enough tht they met our definition of WMSD. Therpists with WMSDs were less likely to report their WMSD thn those with WRI were but more likely to stte tht prctice excerbted their symptoms nd just s likely to work in pin nd lter work hbits. Of prticulr concern is tht 53% of occuptionl therpists with WMSD or injury nd 65% of physicl therpists with WMSD or injury reported tht they were considering chnging or hd chnged jobs becuse of their injury or WMSD. We do not know wht proportion would leve the profession rther thn chnge prctice re. Even so, this finding deserves serious ttention given the projected need for therpists (BLS, 2004) nd the potentil loss of experienced prctitioners to other prctice settings or professions. Therpists my not be reporting injury becuse they re ble to self-tret, recognize erly symptoms of n injury, nd ccess clinicl collegues (Wldrop, 2004). More thn hlf of the occuptionl therpists nd physicl therpists in this study reported tht they self-treted injuries nd WMSDs, The Americn Journl of Occuptionl Therpy 359 Downloded From: on 2/0/207 Terms of Use:
10 Tble 8. Culturl nd Work Prctice Fctors Among Physicl Therpists nd Occuptionl Therpists With Pin nd With Work-Relted Musculoskeletl Disorders (WMSDs) Fctor Pin (n) WMSD (n) Person χ 2 df p Reported injury to workplce 0. (0/93) 0.22 (5/67) * 0.08 (4/76) 0.08 (7/86) Sought tretment 0.44 (4/93) 0.70 (47/67) * 0.32 (56/77) 0.57 (49/86) * Sought tretment MD/DC: MD/DC: / clinic: / clinic: 0. (0/93) 0.08 (5/78) 0.08 (7/93) 0.06 (/78) 0.34 (23/67) 0.22 (9/86) 0.22 (5/67) 0.4 (2/86) *.002*.007*.036* Collegue: Collegue: 0.6 (5/93) 0.0 (8/78) 0.24 (6/67) 0.23 (20/86) * Self-tret: Self-tret: 0.38 (35/93) 0.34 (60/78) 0.60 (40/67) 0.43 (37/86) *.4 Missed work becuse of pin 0.02 (2/93) 0.06 (4/67) (2/78) 0.04 (3/86) Worked while in pin 0.89 (83/93) 0.97 (65/67) (6/75) 0.98 (84/86) Pin interfered with work 0.6 (5/93) 0.39 (26/67) * 0.5 (26/75) 0.33 (28/85).37.00* Altered work hbits 0.63 (58/92) 0.78 (52/67) * 0.53 (95/78) 0.73 (63/86) * Limited ptient contct time 0.07 (6/92) 0.06 (4/67) (3/76) 0.5 (3/86) * Prctice excerbted pin 0.65 (59/9) 0.83 (55/66) * 0.66 (7/78) 0.87 (75/86).09.00* Considering chnging jobs 0.04 (4/9) 0.6 (/67) * 0.05 (8/76) 0.26 (22/86) * Chnged jobs becuse of injury 0.03 (3/93) 0.09 (6/67) (8/75) 0.09 (8/86) Note. = physicl therpist; = occuptionl therpist; MD = medicl doctor; DC = chiroprctor. p vlues obtined through independent smples, two-tiled t test. *Sttisticlly significnt t p.05. nd pproximtely one-fourth indicted they sought tretment from collegue. Therpists lso reported tht they ltered their work prctices becuse of their injury or disorder. Both occuptionl nd physicl therpists help clients nd ptients dpt their work environments to ccommodte disbility, injury, or discomfort. If they use these skills to protect themselves nd continue working, they my see no reson to report the injury. Other studies suggest tht therpists my perceive the injury s wekness on their prt becuse of their expertise in the re of ptient hndling nd movement (Cromie et l., 2002). Therpists lso ply role in preserving the occuptionl helth of their collegues. Occuptionl nd physicl therpists hve dul role within mny helth cre settings. For exmple, within the hospitl system, occuptionl therpists nd physicl therpists re often responsible for trining 360 My/June 2009, Volume 63, Number 3 Downloded From: on 2/0/207 Terms of Use:
11 ptient cre stff in good body mechnics to void injury (Drrgh, Cmpo, & Olson, in press). Reporting n injury tht they tech others to prevent could be mjor brrier. Therpists rely on good body mechnics to void injury. As these dt indicte, however, good body mechnics lone cnnot protect therpists from injury. Biomechnicl evidence confirms this finding nd hs demonstrted tht there is no sfe wy to lift dependent ptient (Mrrs, Dvis, Kirking, & Bertsche, 999). Even trnsfer tsk with light ptient who is complint results in spinl loding tht exceeds tissue thresholds (Mrrs et l., 999; Ulin et l., 997). Reserch hs demonstrted tht using sfe ptient hndling guidelines cn reduce musculoskeletl injuries nd disorders mong nursing personnel while improving ptient sfety (Collins et l., 2004; Grg & Owen, 992; Nelson & Frgl, 2004; Yssi et l., 200). Miniml-lift nd no-lift progrms hve been implemented in mny medicl fcilities, nd therpists will be expected to trin nursing personnel in the use of the equipment nd to integrte the equipment nd lifting restrictions into prctice. Although mechnicl lift devices nd other miniml-lift equipment cn protect therpists from some musculoskeletl injuries nd disorders, therpists must lso consider the best wy to fcilitte independence in their ptients while reducing the mount of unssisted hndling they perform. Limittions of the Study The current study hs severl limittions. First, s crosssectionl study tht relies on self-report, it hs the possibility of selection bis nd recll bis. The fct tht the prevlence mong physicl therpists is similr to or lower thn other studies, especilly the prospective study by Cmpo et l. (2008), improves the vlidity of these findings, but the bis remins. The response rte ws 36%, which could indicte bised smple. Future studies will ddress bis by using personlized, ddressed envelopes; incentives (such s coffee crds); nd stmps insted of bulk miling. These strtegies resulted in 93% response rte in the study of physicl therpists by Cmpo et l. (2008). Becuse the study relied on self-report of injury, we did not identify the proportion of injuries nd WMSDs tht would be considered recordble by Occuptionl Sfety nd Helth Administrtion stndrds; thus, it is possible the rtes nd prevlence could be inflted. In ddition, the survey did not include questions bout psychosocil fctors tht my contribute to WMSD nd WRI nd could therefore not include this informtion in the nlyses. This study cnnot provide informtion bout predicting injuries; it cn only exmine ssocitions between vribles. A longitudinl study to develop predictive model of injury nd WMSD in occuptionl therpists would be powerful contribution to this knowledge bse. Finlly, this study is limited to therpists in Wisconsin. Whether these therpists differ from those in other sttes is unknown, but differences could limit generlizbility. Recommendtions for Further Reserch The current study identified the scope of the problem of WRI, symptoms, nd WMSD. Further reserch is needed to identify the effects on occuptionl therpists nd physicl therpists of working injured or while in pin. The verge ge of the therpists in the current study ws pproximtely 43 yers with n verge of 7 yers of experience; 35% reported t lest one injury or WMSD within 3-yer period. If we include respondents who reported pin or discomfort, we see tht bout 60% of therpists hve experienced or re experiencing work-relted symptoms, injuries, nd disorders, nd lmost ll respondents hve worked while injured or in pin. This behvior cn result in presenteeism, phenomenon in which workers continue to work with injuries or illnesses nd experience decresed productivity or qulity of work (Pilette, 2005). Reserch on other occuptions experiencing this phenomenon demonstrtes tht presenteeism cn result in deleterious physicl nd psychosocil effects (Goetzel et l., 2004; Stewrt, Ricci, Chee, Morgnstein, & Lipton, 2003). Although therpists with injuries nd WMSDs sustin injuries severe enough tht they re in pin when they prctice, lter their work hbits nd, in some cses, limit ptient contct time, presenteeism hs not been explored. The need for occuptionl therpists nd physicl therpists is predicted to grow much fster thn tht for ll other occuptions through 204 s the popultion ges. A study of the impct of presenteeism in the proposed popultions is urgently needed (BLS, 2004). In ddition, reserch into the exposures tht plce therpists t risk is necessry to prevent injury. More detiled observtionl exposure nlyses re wrrnted. Reserch exmining the usefulness nd effects of sfe ptient hndling nd movement lgorithms nd equipment in the context of therpy must be pursued. Conclusions Occuptionl therpists nd physicl therpists re t substntil risk of WRIs nd WMSDs. Prevention of these conditions is limited by underreporting nd ltruistic behvior on the prt of the therpists. Of concern is the tendency of therpists to continue to work while in pin or with workrelted musculoskeletl injury or disorder, even while excerbting their condition. The long-term physicl nd psychosocil effects of this behvior must be explored. Finlly, therpists must mke shift wy from their relince on body mechnics lone s protection ginst injury. Occuptionl The Americn Journl of Occuptionl Therpy 36 Downloded From: on 2/0/207 Terms of Use:
12 therpy prctitioners must exmine the integrtion of sfe ptient hndling nd movement devices nd recommendtions into therpy. s Acknowledgments This study ws supported, in prt, by University of Wisconsin Milwukee College of Helth Sciences Stimulus for Extrmurl Enhncement nd Development grnt. References Alnser, M. Z. (2007, April). Perspectives on occuptionl musculoskeletl injuries incurred by occuptionl therpy prctitioners. Pper presented t the Americn Occuptionl Therpy Associ tion 87th Annul Conference & Expo, St. Louis, MO. Bork, B. E., Cook, T. M., Rosencrnce, J. C., Englehrdt, K. A., Thomson, M. E., Wuford, I. J., et l. (996). Work-relted musculoskeletl disorders mong physicl therpists. Physicl Therpy, 76, Bureu of Lbor Sttistics. (2004). Tbles R9 R2: Occuption selected cse chrcteristics, Retrieved October, 2006, from Bureu of Lbor Sttistics. (2006). Tble SNR0. Highest incidence rtes of totl nonftl occuptionl injury nd illness cses, privte industry, Retrieved December 0, 2007, from Bureu of Lbor Sttistics. (2007). Injuries, illnesses, nd ftlities: How to compute firm s incidence rte for sfety mngement. Retrieved April 2, 2008, from Cmpo, M., Weiser, S, Koenig, K. L., & Nordin, M. (2008). Work-relted musculoskeletl disorders in physicl therpists: A prospective cohort study with -yer follow-up. Physicl Therpy, 88, Collins, J. W., Wolf, L., Bell, J., & Evnoff, B. (2004). An evlution of best prctices musculoskeletl injury prevention progrm in nursing homes. Injury Prevention, 0, Cromie, J. E., Robertson, V. J., & Best, M. O. (2000). Workrelted musculoskeletl disorders in physicl therpists: Prevlence, severity, risks, nd responses. Physicl Therpy, 80, Cromie, J. E., Robertson, V. J., & Best, M. O. (2002). Workrelted musculoskeletl disorders nd the culture of physicl therpy. Physicl Therpy, 82, Drrgh, A. R., Cmpo, M., & Olson, D. (in press). Sfe ptient hndling nd movement: A qulittive study of occuptionl nd physicl therpists. Work: A Journl of Prevention, Assessment, nd Rehbilittion. Engkvist, I. (2006). Evlution of n intervention comprising no lifting policy in Austrlin hospitls. Applied Ergonomics, 37, Grg, A., & Owen, B. D. (992). Reducing bck stress to nursing personnel: An ergonomic intervention in nursing home. Ergonomics, 35, Glover, W., McGregor, A., Sullivn, C., & Hgue, J. (2005). Work-relted musculoskeletl disorders ffecting members of the Chrtered Society of Physiotherpy. Physiotherpy, 9, Goetzel, R. Z., Long, S. R., Ozminkowski, R. J., Hwkins, K., Wng, S., & Lynch, W. (2004). Helth, bsence, disbility, nd presenteeism cost estimtes of certin physicl nd mentl helth conditions ffecting U.S. employers. Journl of Occuptionl nd Environmentl Medicine, 46, Henszel, W., Lovelnd, D. B., & Sirken, M. G. (962). Lung cncer mortlity s relted to residence nd smoking histories. Journl of the Ntionl Cncer Institute, 28, Hignett, S. (996). Work-relted bck pin in nurses. Journl of Advnced Nursing, 23, Hignett, S. (200). Mnul hndling risk ssessments in occuptionl therpy. British Journl of Occuptionl Therpy, 64, Holder, N. L., Clrk, H. A., DiBlsio, J. M., Hughes, C. L., Schepf, J. W., Hrding, L., et l. (999). Cuse, prevlence, nd response to occuptionl musculoskeletl injuries reported by physicl therpists nd physicl therpy ssistnts. Physicl Therpy, 79, Mrrs, W. S., Dvis, K. G., Kirking, B. C., & Bertsche, P. K. (999). A comprehensive nlysis of low-bck disorder risk nd spinl loding during the trnsferring nd repositioning of ptients using different techniques. Ergonomics, 42, Mierzejewski, M., & Kumr, S. (997). Prevlence of low bck pin mong physicl therpists in Edmonton, Albert. Disbility nd Rehbilittion, 9, Miller, A., Engst, C., Tte, R. B., & Yssi, A. (2006). Evlution of the effectiveness of portble ceiling lifts in new long-term cre fcility. Applied Ergonomics, 37, Molumphy, M., Unger, B., Jensen, G., & Lopopolo, R. (985). Incidence of work-relted low bck pin in physicl therpists. Physicl Therpy, 65, Nelson, A., & Frgl, G. (2004). Equipment for sfe ptient hndling nd movements. In W. Chrney & A. Hudson (Eds.), Bck injury mong helth cre workers: Cuses, solutions, nd impcts (pp. 2 35). Boc Rton, FL: Lewis. Pilette, P. C. (2005). Presenteeism in nursing: A cler nd present dnger to productivity. Journl of Nursing Administrtion, 35, Scholey, M., & Hir, M. (989). Bck pin in physiotherpists working in bck eduction. Ergonomics, 32, Stewrt, W. F., Ricci, J. A., Chee, E., Morgnstein, D., & Lipton, R. (2003). Lost productive time nd cost due to common pin conditions in the U.S. workforce. JAMA, 290, Ulin, S. S., Chffin, D. B., Ptellos, C. L., Blitz, S. G., Emerick, C. A., & Lundy F. (997). A biomechnicl nlysis of methods used for trnsferring totlly dependent ptients. Spinl Cord Injury Nursing Journl, 4, Wldrop, S. (2004). Work-relted injuries: Preventing the from becoming the ptient. Mgzine of Physicl Therpy, 2(2), West, D. J., & Grdner, D. (200). Occuptionl injuries of physiotherpists in North nd Centrl Queenslnd. Austrlin Journl of Physiotherpy, 47, Yssi, A., Cooper, J. E., Tte, R. B., Gerlch, S., Muir, M., & Trottier, J. (200). A rndomized controlled tril to prevent ptient lift nd trnsfer injuries of helth cre workers. Spine, 26, My/June 2009, Volume 63, Number 3 Downloded From: on 2/0/207 Terms of Use:
Supplementary Online Content
Supplementry Online Content Zulmn DM, Pl Chee C, Ezeji-Okoye SC, et l. Effect of n intensive outptient progrm to ugment primry cre for high-need Veterns Affirs ptients: rndomized clinicl tril. JAMA Intern
More informationXII. HIV/AIDS. Knowledge about HIV Transmission and Misconceptions about HIV
XII. HIV/AIDS Knowledge bout HIV Trnsmission nd Misconceptions bout HIV One of the most importnt prerequisites for reducing the rte of HIV infection is ccurte knowledge of how HIV is trnsmitted nd strtegies
More informationCommunity. Profile Lewis & Clark County. Public Health and Safety Division
Community Helth Profile 2015 Lewis & Clrk County Public Helth nd Sfety Division Tble of Contents Demogrphic Informtion 1 Communicble Disese 3 Chronic Disese 4 Mternl nd Child Helth 10 Mortlity 12 Behviorl
More informationAssessment of Depression in Multiple Sclerosis. Validity of Including Somatic Items on the Beck Depression Inventory II
Assessment of Depression in Multiple Sclerosis Vlidity of Including Somtic Items on the Beck Depression Inventory II Peggy Crwford, PhD; Noh J. Webster, MA Signs nd symptoms of multiple sclerosis (MS)
More informationCommunity. Profile Big Horn County. Public Health and Safety Division
Community Helth Profile 2015 Big Horn County Public Helth nd Sfety Division Tble of Contents Demogrphic Informtion 1 Communicble Disese 3 Chronic Disese 4 Mternl nd Child Helth 10 Mortlity 12 Behviorl
More informationCommunity. Profile Powell County. Public Health and Safety Division
Community Helth Profile 2015 Powell County Public Helth nd Sfety Division Tble of Contents Demogrphic Informtion 1 Communicble Disese 3 Chronic Disese 4 Mternl nd Child Helth 10 Mortlity 12 Behviorl Risk
More informationClinical Study Report Synopsis Drug Substance Naloxegol Study Code D3820C00018 Edition Number 1 Date 01 February 2013 EudraCT Number
EudrCT Number 2012-001531-31 A Phse I, Rndomised, Open-lbel, 3-wy Cross-over Study in Helthy Volunteers to Demonstrte the Bioequivlence of the Nloxegol 25 mg Commercil nd Phse III Formultions nd to Assess
More informationCommunity. Profile Yellowstone County. Public Health and Safety Division
Community Helth Profile 2015 Yellowstone County Public Helth nd Sfety Division Tble of Contents Demogrphic Informtion 1 Communicble Disese 3 Chronic Disese 4 Mternl nd Child Helth 10 Mortlity 12 Behviorl
More informationCommunity. Profile Missoula County. Public Health and Safety Division
Community Helth Profile 2015 Missoul County Public Helth nd Sfety Division Tble of Contents Demogrphic Informtion 1 Communicble Disese 3 Chronic Disese 4 Mternl nd Child Helth 10 Mortlity 12 Behviorl Risk
More informationCommunity. Profile Anaconda- Deer Lodge County. Public Health and Safety Division
Community Helth Profile 2015 Ancond- Deer Lodge County Public Helth nd Sfety Division Tble of Contents Demogrphic Informtion 1 Communicble Disese 3 Chronic Disese 4 Mternl nd Child Helth 10 Mortlity 12
More informationSummary. Effect evaluation of the Rehabilitation of Drug-Addicted Offenders Act (SOV)
Summry Effect evlution of the Rehbilittion of Drug-Addicted Offenders Act (SOV) The Rehbilittion of Drug-Addicted Offenders Act (SOV) ws lunched on April first 2001. This lw permitted the compulsory plcement
More informationCommunity. Profile Carter County. Public Health and Safety Division
Community Helth Profile 2015 Crter County Public Helth nd Sfety Division Tble of Contents Demogrphic Informtion 1 Communicble Disese 3 Chronic Disese 4 Mternl nd Child Helth 10 Mortlity 12 Behviorl Risk
More informationCheckMate 153: Randomized Results of Continuous vs 1-Year Fixed-Duration Nivolumab in Patients With Advanced Non-Small Cell Lung Cancer
CheckMte 53: Rndomized Results of Continuous vs -Yer Fixed-Durtion Nivolumb in Ptients With Advnced Non-Smll Cell Lung Cncer Abstrct 297O Spigel DR, McCleod M, Hussein MA, Wterhouse DM, Einhorn L, Horn
More informationResearch Article Patterns of Cancer Genetic Testing: A Randomized Survey of Oregon Clinicians
Hindwi Publishing Corportion Journl of Cncer Epidemiology Volume 2012, Article ID 294730, 11 pges doi:10.1155/2012/294730 Reserch Article Ptterns of Cncer Genetic Testing: A Rndomized Survey of Oregon
More informationComputer-Aided Learning in Insulin Pump Training
Journl of Dibetes Science nd Technology Volume 4, Issue 4, July 2010 Dibetes Technology Society TECHNOLOGY REPORTS Computer-Aided Lerning in Insulin Pump Trining Sergey V., M.Sc., 1 nd Chrles J. George,
More informationEVALUATION OF DIFFERENT COPPER SOURCES AS A GROWTH PROMOTER IN SWINE FINISHING DIETS 1
Swine Dy 2001 Contents EVALUATION OF DIFFERENT COPPER SOURCES AS A GROWTH PROMOTER IN SWINE FINISHING DIETS 1 C. W. Hstd, S. S. Dritz 2, J. L. Nelssen, M. D. Tokch, nd R. D. Goodbnd Summry Two trils were
More informationPNEUMOVAX 23 is recommended by the CDC for all your appropriate adult patients at increased risk for pneumococcal disease 1,2 :
PNEUMOVAX 23 is recommended y the CDC for ll your pproprite dult ptients t incresed risk for pneumococcl disese 1,2 : Adults ged
More informationURINARY incontinence is an important and common
Urinry incontinence in older people in the community: neglected problem? Helen Stoddrt, Jenny Donovn, Elise Whitley, Deborh Shrp nd In Hrvey SUMMARY Bckground: The prevlence nd impct of urinry incontinence
More informationRecall Bias in Childhood Atopic Diseases Among Adults in The Odense Adolescence Cohort Study
Syddnsk Universitet Recll Bis in Childhood Atopic Diseses Among Adults in The Odense Adolescence Cohort Study Mørtz, Chrlotte G; Andersen, Klus Ejner; Bindslev-Jensen, Crsten Published in: Act Dermto-Venereologic
More informationThe Acute Time Course of Concurrent Activation Potentiation
Mrquette University e-publictions@mrquette Exercise Science Fculty Reserch nd Publictions Exercise Science, Deprtment of 1-1-2010 The Acute Time Course of Concurrent Activtion Potentition Luke Grceu Mrquette
More informationFactors influencing help seeking in mentally distressed young adults: a cross-sectional survey
L Biddle, D Gunnell, D Shrp nd J L Donovn Fctors influencing help seeking in mentlly distressed young dults: cross-sectionl survey Lucy Biddle, Dvid Gunnell, Debbie Shrp nd Jenny L Donovn SUMMARY Bckground:
More informationAbstract. Background. Aim. Patients and Methods. Patients. Study Design
Impct of the Use of Drugs nd Substitution Tretments on the Antivirl Tretment of Chronic Heptitis C: Anlysis of Complince, Virologicl Response nd Qulity of Life (CHEOBS). Melin, 1 J.-. Lng, D. Ouzn, 3 M.
More informationHealth-Related Quality of Life and Symptoms of Depression in Extremely Obese Persons Seeking Bariatric Surgery
Oesity Surgery, 15, 3-39 Helth-Relted Qulity of Life nd Symptoms of Depression in Extremely Oese Persons Seeking Britric Surgery Anthony N. Frictore, PhD; Thoms A. Wdden, PhD; Dvid B. Srwer, PhD; Myles
More informationReducing the Risk. Logic Model
Reducing the Risk Logic Model ETR (Eduction, Trining nd Reserch) is nonprofit orgniztion committed to providing science-bsed innovtive solutions in helth nd eduction designed to chieve trnsformtive chnge
More informationThe Effects of Small Sized Rice Bowl on Carbohydrate Intake and Dietary Patterns in Women with Type 2 Diabetes
Originl Article doi: 10.4093/kdj.2010.34.3.166 pissn 1976-9180 eissn 2093-2650 The Effects of Smll Sized Rice Bowl on Crbohydrte Intke nd Dietry Ptterns in Women with Type 2 Dibetes Hee-Jung Ahn 1, *,
More informationHealth Coaching: A Preliminary Report on the Effects in Traumatic Brain Injury/Polytrauma Patients
ORIGINAL RESEARCH Helth Coching: A Preliminry Report on the Effects in Trumtic Brin Injury/Polytrum Ptients Esmerld Mdrigl, MSW; Mx Gry, BA; Molly A. Timmermn, DO; Ttin Orozco, PhD; Dine Cowper Ripley,
More informationAppendix J Environmental Justice Populations
Appendix J Environmentl Justice s [This pge intentionlly left blnk] Tble of Contents REFERENCES...J-2 Pge LIST OF TABLES Pge Tble J-1: Demogrphic Overview of Bruinsburg Site Project Are... J-3 Tble J-2:
More informationMetabolic Syndrome and Health-related Quality of Life in Obese Individuals Seeking Weight Reduction
Metbolic Syndrome nd Helth-relted Qulity of Life in Obese Individuls Seeking Weight Reduction Adm Gilden Tsi 1, Thoms A. Wdden 1, Dvid B. Srwer 1, Robert I. Berkowitz 1, Leslie G. Womble 1, Louise A. Hesson
More informationEstimated Prevalence and Economic Burden of Severe, Uncontrolled Asthma in the United States
Estimted Prevlence nd Economic Burden of Severe, Uncontrolled Asthm in the United Sttes Cheryl S. Hnkin 1 ; Amy Bronstone 1 ; Zhohui Wng 1 ; Mry Butti-Smll 2 ; Philip O. Buck 2 1 BioMedEcon, Moss Bech,
More informationMultiple sclerosis (MS) affects approximately. Triaging Patients with Multiple Sclerosis in the Emergency Department. Room for Improvement
Systemtic Review of Tools for Anxiety in MS MS CARE DELIVERY: CHALLENGES AND INVATIONS Triging Ptients with Multiple Sclerosis in the Emergency Deprtment Room for Improvement Heshm Abboud, MD, PhD; Krin
More informationEffect of Preoperative Intravenous Methocarbamol and Intravenous Acetaminophen on Opioid Use After Primary Total Hip and Knee Replacement
Feture Article Effect of Preopertive Intrvenous Methocrbmol nd Intrvenous Acetminophen on Opioid Use After Primry Totl Hip nd Knee Replcement THOMAS D. LOOKE, MD, PHD; CAMERON T. KLUTH, MBA bstrct Between
More informationPotential for Interactions Between Dietary Supplements and Prescription Medications a
CLINICAL RESEARCH STUDY Potentil for Interctions Between Dietry Supplements nd Prescription Medictions Amit Sood, MD, MSc, Rich Sood, MD, b Frncis J. Brinker, ND, Rvneet Mnn, MBBS, c Lur L. Loehrer, Dietlind
More informationGeographical influence on digit ratio (2D:4D): a case study of Andoni and Ikwerre ethnic groups in Niger delta, Nigeria.
Journl of Applied Biosciences 27: 1736-1741 ISSN 1997 5902 Geogrphicl influence on digit rtio (2D:4D): cse study of Andoni nd Ikwerre ethnic groups in Niger delt, Nigeri. Gwunirem, Isrel U 1 nd Ihemelndu,
More informationPreliminary Findings of a Randomized Controlled Trial of an Interdisciplinary Military Pain Program
MILITARY MEDICINE, 174, 3:270, 2009 Preliminry Findings of Rndomized Controlled Tril of n Interdisciplinry Militry Pin Progrm Robert J. Gtchel, PhD * ; Donld D. McGery, PhD ; Aln Peterson, PhD ; Mysti
More informationORIGINAL ARTICLE. Diagnostic Signs of Accommodative Insufficiency. PILAR CACHO, OD, ÁNGEL GARCÍA, OD, FRANCISCO LARA, OD, and M A MAR SEGUÍ, OD
1040-5488/02/7909-0614/0 VOL. 79, NO. 9, PP. 614 620 OPTOMETRY AND VISION SCIENCE Copyright 2002 Americn Acdemy of Optometry ORIGINAL ARTICLE Dignostic Signs of Accommodtive Insufficiency PILAR CACHO,
More informationSeasonal influenza vaccination programme country profile: Ireland
Sesonl influenz vccintion progrmme country profile: Irelnd 2012 13 Seson Bckground informtion Influenz immunistion policy nd generl fcts bout Irelnd Volume indices of GDP per cpit in 2011 nd 2013 (EU-
More informationBody mass index, waist-to-hip ratio, and metabolic syndrome as predictors of middle-aged men's health
Originl Article - Sexul Dysfunction/Infertility pissn 2005-6737 eissn 2005-6745 Body mss index, wist-to-hip rtio, nd metbolic syndrome s predictors of middle-ged men's helth Jung Hyun Prk *, In-Chng Cho
More informationAddendum to the Evidence Review Group Report on Aripiprazole for the treatment of schizophrenia in adolescents (aged years)
Addendum to the Evidence Review Group Report on Aripiprzole for the tretment of schizophreni in dolescents (ged 15-17 yers) Produced by Authors Correspondence to Southmpton Helth Technology Assessments
More informationChilblains (pernio, perniosis) are cold-induced, painful or itching
Nifedipine vs Plcebo for Tretment of Chronic Chilblins: A Rndomized Controlled Tril Ibo H. Souwer, MD 1 Jcobus H. J. Bor, BSc (Mth) 2 Pul Smits, MD, PhD 3 Antoine L. M. Lgro-Jnssen, MD, PhD 1 1 Deprtment
More informationBMI and Mortality: Results From a National Longitudinal Study of Canadian Adults
nture publishing group BMI nd Mortlity: Results From Ntionl Longitudinl Study of Cndin Adults Hether M. Orpn 1, Jen-Mrie Berthelot 2,3, Mrk S. Kpln 4, Dvid H. Feeny 5,6, Bentson McFrlnd 7 nd Nncy A. Ross
More informationLongitudinal Association of Maternal Attempt to Lose Weight During the Postpartum Period and Child Obesity at Age 3 Years
nture publishing group Longitudinl Assocition of Mternl Attempt to Lose Weight During the Postprtum Period nd Child Obesity t Age 3 Yers Kendrin R. Sonneville 1,2, Sheryl L. Rifs-Shimn 3, Emily Oken 3,
More informationPrevalence, Correlates and Characteristics of Chronic Pruritus: A Population-based Cross-sectional Study
Act Derm Venereol 2011; 91: 674 679 INVESTIGATIVE REPORT Prevlence, Correltes nd Chrcteristics of Chronic Pruritus: A Popultion-bsed Cross-sectionl Study Uwe Mtterne 1, Christin J. Apfelbcher 1, Adrin
More informationReview TEACHING FOR GENERALIZATION & MAINTENANCE
Gols By the end of clss, you should be ble to: Explin wht generliztion is, why it is criticl for techers to know how to tech so tht it occurs, nd give n exmple of it from your own experience in the clssroom
More informationOpioid Use and Survival at the End of Life: A Survey of a Hospice Population
532 Journl of Pin nd Symptom Mngement Vol. 32 No. 6 December 2006 NHPCO Originl Article Opioid Use nd Survivl t the End of Life: A Survey of Hospice Popultion Russell K. Portenoy, MD, Un Sibircev, BA,
More informationUsing Paclobutrazol to Suppress Inflorescence Height of Potted Phalaenopsis Orchids
Using Pcloutrzol to Suppress Inflorescence Height of Potted Phlenopsis Orchids A REPORT SUBMITTED TO FINE AMERICAS Linsey Newton nd Erik Runkle Deprtment of Horticulture Spring 28 Using Pcloutrzol to Suppress
More informationA series of recent studies and meta-analyses confirm
Originl Reserch Clinicl Medicine & Reserch Volume 11, Number 4: 210-218 2013 Mrshfield Clinic clinmedres.org Brest nd Prostte Cncer Survivors in Dibetic Cohort: Results from the Living With Dibetes Study
More informationEvaluation of a task-oriented client-centered upper extremity skilled performance training module in persons with tetraplegia
(2011) 49, 1049 1054 & 2011 Interntionl Society All rights reserved 1362-4393/11 $32.00 www.nture.com/sc ORIGINAL ARTICLE Evlution of tsk-oriented client-centered upper extremity skilled performnce trining
More informationManagement and Outcomes of Binge-Eating Disorder in Adults: Current State of the Evidence
Clinicin Summry Mentl Helth Eting Disorders Mngement nd Outcomes of Binge-Eting Disorder in Adults: Current Stte of the Evidence Focus of This Summry This is summry of systemtic review evluting the evidence
More informationInadequate health literacy is a
Testing the BRIEF Helth Litercy Screening Tool Jolie Hun, PhD, Virgini Nolnd-Dodd, PhD, MPH, Jill Vrnes, EdD, John Grhm-Pole, MD, Brbr Rienzo, PhD, nd Ptrici Donldson, RN Due to the oppressive strins lid
More informationThe potential future of targeted radionuclide therapy: implications for occupational exposure? P. Covens
The potentil future of trgeted rdionuclide therpy: implictions for occuptionl exposure? Introduction: Trgeted Rdionuclide Therpy (TRT) Systemic tretment Molecule lbelled with rdionuclide delivers toxic
More informationUniversity of Texas Health Science Center, San Antonio, San Antonio, Texas, USA
Lung Cncer Chemotherpy Given Ner the End of Life by Community Oncologists for Advnced Non-Smll Cell Lung Cncer Jose R. Murillo, Jr., Jim Koeller b,c Methodist Hospitl, Houston, Texs, USA; b University
More informationA review of the patterns of docetaxel use for hormone-resistant prostate cancer at the Princess Margaret Hospital
MEDICAL ONCOLOGY A review of the ptterns of docetxel use for hormone-resistnt prostte cncer t the Princess Mrgret Hospitl S.N. Chin MD,* L. Wng MSc, M. Moore MD,* nd S.S. Sridhr MD MSc* ABSTRACT Bckground
More informationFat intake in patients newly diagnosed with type 2 diabetes: a 4-year follow-up study in general practice
Originl ppers Ft intke in ptients newly dignosed with type 2 dibetes: 4-yer follow-up study in generl prctice Floris A vn de Lr, Eloy H vn de Lisdonk, Peter L B J Lucssen, J M H Tigchelr, Sski Meyboom,
More informationEFFECTS OF INGREDIENT AND WHOLE DIET IRRADIATION ON NURSERY PIG PERFORMANCE
Swine Dy 21 EFFECTS OF INGREDIENT AND WHOLE DIET IRRADIATION ON NURSERY PIG PERFORMANCE J. M. DeRouchey, M. D. Tokch, J. L. Nelssen, R. D. Goodbnd, S. S. Dritz 1, J. C. Woodworth, M. J. Webster, B. W.
More informationImpact of Pharmacist Intervention on Diabetes Patients in an Ambulatory Setting
Impct of Phrmcist Intervention on Dibetes Ptients in n Ambultory Setting Julie Stding, PhrmD, CDE, Jmie Herrmnn, PhrmD, Ryn Wlters, MS, Chris Destche, PhrmD, nd Aln Chock, PhrmD Dibetes is the seventh-leding
More informationEffects of physical exercise on working memory and prefrontal cortex function in post-stroke patients
Effects of physicl exercise on working memory nd prefrontl cortex function in post-stroke ptients M Moriy, C Aoki, K Sktni Grdute School of Helth Sciences Reserch, Mjor of Physicl Therpy, TeikyoHeisei
More informationUtilization of dental services in Southern China. Lo, ECM; Lin, HC; Wang, ZJ; Wong, MCM; Schwarz, E
Title Utiliztion of dentl services in Southern Chin Author(s) Lo, ECM; Lin, HC; Wng, ZJ; Wong, MCM; Schwrz, E Cittion Journl Of Dentl Reserch, 2001, v. 80 n. 5, p. 1471-1474 Issued Dte 2001 URL http://hdl.hndle.net/10722/53200
More informationA Four-System Comparison of Patients With Chronic Illness: The Military Health System, Veterans Health Administration, Medicaid, and Commercial Plans
MILITARY MEDICINE, 174, 9:936, 2009 A Four-System Comprison of Ptients With Chronic Illness: The Militry Helth System, Veterns Helth Administrtion, Medicid, nd Commercil Plns Teres B. Gibson, PhD * ; Todd
More informationEffectiveness of Belt Positioning Booster Seats: An Updated Assessment
ARTICLES Effectiveness of Belt Positioning Booster Sets: An Updted Assessment AUTHORS: Kristy B. Arbogst, PhD, Jessic S. Jermkin, DSc, Michel J. Klln, MS, b nd Dennis R. Durbin, MD, MSCE,b Center for Injury
More informationIntroduction to Study Designs II
Introdution to Study Designs II Commonly used study designs in publi helth & epidemiologi reserh Benjmin Rihrd H. Muthmbi, DrPH, MPH Stte HIV Epidemiologist HIV Epidemiology Investigtion Setion PA Deprtment
More informationkey words: chronic obstructive pulmonary disease, beta agonists, Medicare, health care costs, health care utilization
reserch report Helth Cre Use nd Costs Among Medicre Ptients With Chronic Obstructive Pulmonry Disese Treted With Short-Acting Bet Agonists or Long-Acting Bet Agonists Flvi Ejzykowicz, PhD; 1 Vmsi K Bollu,
More informationInvasive Pneumococcal Disease Quarterly Report. July September 2017
Invsive Pneumococcl Disese Qurterly Report July September 2017 Prepred s prt of Ministry of Helth contrct for scientific services by Rebekh Roos Helen Heffernn October 2017 Acknowledgements This report
More informationY. Yazici 1, D. Moniz Reed 2, C. Klem 2, L. Rosenblatt 2, G. Wu 2, J.M. Kremer 3
Greter remission rtes in ptients with erly versus long-stnding disese in biologic-nive rheumtoid rthritis ptients treted with btcept: post hoc nlysis of rndomised clinicl tril dt Y. Yzici 1, D. Moniz Reed
More informationPreventive Neuromuscular Training for Young Female Athletes: Comparison of Coach and Athlete Compliance Rates
Journl of Athletic Trining 2016;51(12):000 000 doi: 10.4085/1062-6050-51.12.20 Ó by the Ntionl Athletic Triners Assocition, Inc www.ntjournls.org originl reserch Preventive Neuromusculr Trining for Young
More informationEfficacy of Pembrolizumab in Patients With Advanced Melanoma With Stable Brain Metastases at Baseline: A Pooled Retrospective Analysis
Efficcy of Pembrolizumb in Ptients With Advnced Melnom With Stble Brin Metstses t Bseline: A Pooled Retrospective Anlysis Abstrct 1248PD Hmid O, Ribs A, Dud A, Butler MO, Crlino MS, Hwu WJ, Long GV, Ancell
More informationENERGY CONTENT OF BARLEY
ENERGY CONTENT OF BARLEY VARIATION IN THE DIETARY ENERGY CONTENT OF BARLEY Shwn Firbirn, John Ptience, Hnk Clssen nd Ruurd Zijlstr SUMMARY Formultion of commercil pig diets requires n incresing degree
More informationA cross-sectional and follow-up study of leukopenia in tuberculosis patients: prevalence, risk factors and impact of anti-tuberculosis
Originl Article A cross-sectionl nd follow-up study of leukopeni in tuberculosis ptients: prevlence, risk fctors nd impct of nti-tuberculosis tretment Fei-Shen Lin 1 *, Mei-Ying Wu 2 *, Wen-Jun Tu 3, Hong-Qiu
More informationRelationship Between Hospital Performance on a Patient Satisfaction Survey and Surgical Quality
Reserch Originl Investigtion Reltionship Between Hospitl Performnce on Ptient Stisfction Survey nd Surgicl Qulity Greg D. Scks, MD, MPH; Elise H. Lwson, MD, MSHS; Aron J. Dwes, MD; Mrci M. Russell, MD;
More informationUrinary Tract Infection in Men
C H A P T E R 1 9 Urinry Trct Infection in Men Toms L. Griebling, MD Associte Professor & Vice Chir of Urology University of Knss Knss City, Knss Contents INTRODUCTION........................................623
More informationAnalytic hierarchy process-based recreational sports events development strategy research
ISSN : 0974-7435 Volume 0 Issue 6 An Indin Journl Anlytic hierrchy process-bsed recretionl sports events development strtegy reserch Weihu Yo School of hysicl Eduction, Luoyng Norml University, Luoyng
More informationDebra A. Ignaut, R.N., B.S., C.D.E., and Haoda Fu, Ph.D.
Journl of Dietes Science nd Technology Volume 6, Issue 2, Mrch 2012 Dietes Technology Society TECHNOLOGY REPORT Comprison of Insulin Diluent Lekge Postinjection Using Two Different Needle Lengths nd Injection
More informationTHE EVALUATION OF DEHULLED CANOLA MEAL IN THE DIETS OF GROWING AND FINISHING PIGS
THE EVALUATION OF DEHULLED CANOLA MEAL IN THE DIETS OF GROWING AND FINISHING PIGS THE EVALUATION OF DEHULLED CANOLA MEAL IN THE DIETS OF GROWING AND FINISHING PIGS John F. Ptience nd Doug Gillis SUMMARY
More informationWill All Americans Become Overweight or Obese? Estimating the Progression and Cost of the US Obesity Epidemic
nture publishing group rticles Will All s Become Overweight or Obese? Estimting the Progression nd Cost of the US Obesity Epidemic Youf Wng 1, My A. Beydoun 1, Ln Ling 2, Benjmin Cbllero 1 nd Shiriki K.
More informationTHE natural course of sciatica 22,17,23 is favourable in most
Predicting the outcome of scitic t short-term follow-up Ptrick C A J Vroomen, M C T F M de Krom nd J A Knottnerus Originl ppers SUMMARY Bckground: The prognostic vlue of the clinicl findings elicited in
More informationCommunication practices and preferences between orthodontists and general dentists
Originl rticle ommuniction prctices nd preferences between orthodontists nd generl dentists Kevin ibon ; hvn Shroff b ; l M. est c ; Steven J. Linduer d STRT Objective: To evlute similrities nd differences
More informationQuantifying perceived impact of scientific publications
Quntifying perceived impct of scientific publictions Filippo Rdicchi, Alexnder Weissmn, nd John Bollen Center for Complex Networks nd Systems Reserch, School of Informtics nd Computing, Indin University,
More informationSYNOPSIS Final Abbreviated Clinical Study Report for Study CA ABBREVIATED REPORT
Finl Arevited Clinicl Study Report Nme of Sponsor/Compny: Bristol-Myers Squi Ipilimum Individul Study Tle Referring to the Dossier (For Ntionl Authority Use Only) Nme of Finished Product: Yervoy Nme of
More informationInput from external experts and manufacturer on the 2 nd draft project plan Stool DNA testing for early detection of colorectal cancer
Input externl experts nd mnufcturer on the 2 nd drft project pln Stool DNA testing for erly detection of colorectl cncer (Project ID:OTJA10) All s nd uthor s replies on the 2nd drft project pln Stool DNA
More informationThe diagnosis of autism and Asperger syndrome: findings from a survey of 770 families
The dignosis of utism nd Asperger syndrome: findings from survey of 770 fmilies Ptrici Howlin*, Deprtment of Psychology, St George s Hospitl Medicl School, London; Ann Asghrin, Deprtment of Psychology,
More informationLevel of physical activity in the week preceding an ischemic stroke
Dnish University Colleges Level of physicl ctivity in the week preceding n ischemic stroke Lindhl, Mrinne Pi; Krrup LH, Truelsen T, Pedersen A, Lerke H, Lindhl M, Hnsen L, Schrling H, Boysen G. Published
More informationReports of cases of AIDS, HIV infection, and HIV/AIDS 1
Reports of cses of AIDS, HIV infection, nd HIV/AIDS 1 The HIV/AIDS Surveillnce Report is published nnully by the Division of HIV/AIDS Prevention Surveillnce nd Epidemiology, Ntionl Center for HIV, STD,
More informationIn 2006, the prevalence of bipolar
With Bipolr Disorder Annette M. Mtthews, MD; Vness B. Wilson, BA; Suznne H. Mitchell, PhD; nd Peter Huser, MD This study of smoking ehviors nd smoking chrcteristics in veterns with ipolr disorder contriutes
More informationThe Measurement of Interviewer Variance
66 TWO STUDIES OF INTERVIEWER VARIANCE OF SOCIO- PSYCHOLOGICAL VARIABLES By: Leslie Kish nd Crol W. Slter Survey Reserch Center, University of Michign Introduction We report results obtined in two surveys
More informationHuman Immunodeficiency Virus / Acquired Immunodeficiency Syndrome Knowledge and Risk Factors in Ethiopian Military Personnel
MILITARY MEDICINE, 169, 3:221, 2004 Humn Immunodeficiency Virus / Acquired Immunodeficiency Syndrome Knowledge nd Risk Fctors in Ethiopin Militry Personnel Gurntor: Ludmil N. Bkhirev, MD MPH Contributors:
More informationOriginal Article. T Akter 1, N Islam 2, MA Hoque 3, S Khanam 4, HA khan 5, BK Saha 6. Abstract:
Fridpur Med. Coll. J. 214;9(2):61-67 Originl Article Nebuliztion by Isotonic Mgnesium Sulphte Solution with Provide Erly nd Better Response s Compred to Conventionl Approch ( Plus Norml Sline) in Acute
More informationEstimating the impact of the 2009 influenza A(H1N1) pandemic on mortality in the elderly in Navarre, Spain
Rpid communictions Estimting the impct of the influenz pndemic on mortlity in the elderly in Nvrre, Spin J Cstill (jcstilc@nvrr.es) 1, J Etxeberri 1, E Ardnz 1, Y Floristán 1, R López Escudero 1, M Guevr
More informationDependency on Smartphone Use and Its Association with Anxiety in Korea
Reserch Dependency on Smrtphone Use nd Its Assocition with Anxiety in Kore Kyung Eun Lee, MD Si-Heon Kim, MD Te-Yng H, MD Young-Myong Yoo, MD Ji-Jun Hn, MD Je-Hyuk Jung, MD Je-Yeon Jng, PhD ABSTRACT Objective.
More informationCost of Child Lead Poisoning to Taxpayers in Mahoning County, Ohio
Specil Report on Led Poisoning in Children Cost of Child Led Poisoning to Txpyers in Mhoning County, Ohio Mtthew Stefnk, MPH,b Joe Diorio, MS Lrry Frisch, MD, MPH,b SYNOPSIS Led poisoning in children imposes
More informationTrends in Mortality From COPD Among Adults in the United States
[ Originl Reserch COPD ] Trends in Mortlity From COPD Among Adults in the United Sttes Erl S. Ford, MD, MPH BACKGROUND: COPD imposes lrge public helth burden interntionlly nd in the United Sttes. The objective
More informationKnowledge, Attitude, and Concussion-Reporting Behaviors Among High School Athletes: A Preliminary Study
Journl of Athletic Trining 2013;48(5):645 653 doi: 10.4085/1062-6050-48.3.20 Ó y the Ntionl Athletic Triners Assocition, Inc www.ntjournls.org originl reserch Knowledge, Attitude, nd Concussion-Reporting
More informationEpilepsy & Behavior 20 (2011) Contents lists available at ScienceDirect. Epilepsy & Behavior. journal homepage:
Epilepsy & Behvior 20 (2011) 52 56 Contents lists vilble t ScienceDirect Epilepsy & Behvior journl homepge: www.elsevier.com/locte/yebeh Detecting helth disprities mong Cucsins nd Africn-Americns with
More informationThe RUTHERFORD-2 trial in heterozygous FH: Results and implications
The RUTHERFORD-2 tril in heterozygous FH: Results nd implictions Slide deck kindly supplied s n eductionl resource by Professor Derick Rl MD PhD Crbohydrte & Lipid Metbolism Reserch Unit University of
More informationRates of weight change for black and white Americans over a twenty year period
Interntionl Journl of Obesity (2003) 27, 498 504 & 2003 Nture Publishing Group All rights reserved 0307-0565/03 $25.00 www.nture.com/ijo PAPER Rtes of weight chnge for blck nd white Americns over twenty
More informationMecadox. Improves pig performance in a wide range of health and growing conditions. (Carbadox) Talk With a Phibro Expert:
SWINE (Crbdox) Improves pig performnce in wide rnge of helth nd growing conditions The Advntge Over the yers, medicted feed dditive hs proven to be cost-effective mngement tool for improving pig performnce
More informationJ Arab Soc Med Res 9: The Arab Society for Medical Research
6 Originl rticle Assessment of complince to stndrd precutions mong surgeons in Zgzig University Hospitls, Egypt, using the Helth Belief Model Emn M. Mortd, Mrw M. Zlt b Deprtments of C ommunity Medicine
More informationPatient Survival After Surgical Treatment of Rectal Cancer
Originl Article Ptient Survivl After Surgicl Tretment of Rectl Cncer Impct of Surgeon nd Hospitl Chrcteristics Dvid A. Etzioni, MD, MSHS 1,2 ; Toni M. Young-Fdok, MD, MS 1 ; Robert R. Cim, MD, MA 2,3 ;
More informationPAMPHLET. Texas Veterans Commission. Post-Traumatic (PTSD) Stress Distorder TXD V P /NO.3. No. 3, May/June 2008
TXD V 400.6 P191 2008/NO.3 Texs Veterns Commission PAMPHLET No. 3, My/June 2008 TH NVRIYOF TEXAS-PAN AMERICAN 0 1161 0865 0775 Post-Trumtic Stress Distorder (PTSD) The Texs Veterns Commission does not
More informationStaffing Model for Dental Wellness and Readiness
MILITARY MEDICINE, 169, 8:604, 2004 Stffing Model for Dentl Wellness nd Rediness Gurntor: LTC Jeffrey Chffin, DC USA Contributors: COL Lrry G. Rothfuss, DC USA* ; LCDR Scott A. Johnson, NC USN* ; MAJ Stephen
More information