The objective of this study was to identify major occupational factors that were significantly correlated with back pain in pregnant women working in higher education, health care and service areas. A total of 73 working pregnant women were surveyed using questionnaires specifically designed for evaluating correlations between occupational factors and severity of back pain; 37 women were interviewed at both 20 and 34 weeks of pregnancy, 17 at 20 weeks only, and 19 were interviewed at 34 weeks only. "Rest breaks allowed" and "job autonomy" were negatively correlated with severity of back pain at 20 weeks of pregnancy. "Staying in a confined area" and "having restricted space" were positively correlated with severity of back pain at 34 weeks of pregnancy. The study suggests that allowing pregnant women to take more rest breaks and to have more job autonomy may reduce the severity of back pain during early pregnancy, and that allowing movement outside the working area and providing less restricted space may reduce back pain during late pregnancy.
To describe the substitute decision-makers' perspectives related to decision-making in the intensive care unit (ICU) and to determine those variables associated with their overall satisfaction with decision-making.
Prospective, multicenter, cohort study.
Six Canadian university-affiliated ICUs.
We distributed a validated, self-administered questionnaire assessing 21 key aspects of communication and decision-making to substitute decision-makers of ICU patients who were mechanically ventilated for more than 48 h.
A group consisting of 1,123 substitute decision-makers received questionnaires; 789 were returned (70.3% response rate). Respondents were most satisfied with the frequency of communication with nurses and least satisfied with the frequency of communication with physicians. In terms of overall satisfaction with decision-making, 560 (70.9%) of the respondents were either completely or very satisfied. The majority (81.2%) of respondents preferred some form of shared decision-making process. Factors contributing the most to satisfaction with decision-making included: complete satisfaction with level of health care the patient received, completeness of information received, and feeling supported through the decision-making process. Satisfaction with decision-making varied significantly across sites.
In this multicenter observational study, we found that most substitute decision-makers for ICU patients wanted to share decision-making responsibility with physicians and that, overall, they were satisfied with their decision-making experience. Adequate communication, feeling supported, and achieving the appropriate level of care for their family member were key determinants of satisfaction with decision-making in the ICU.
To determine if unrestricted oral carbohydrate intake during labor reduced the incidence of dystocia in low-risk nulliparous women.
A randomized clinical trial at a university-affiliated hospital in southeastern Ontario. Low-risk nulliparous women were randomized between 30 and 40 weeks gestation to either an intervention or usual care group.
Women in the intervention group received, prenatally, guidelines about food and fluid intake during labor and were encouraged to eat and drink as they pleased during labor. Women in the usual care group received no prelabor information and were restricted to ice chips and water during labor in the hospital.
The incidence of dystocia, defined as a cervical dilatation rate of less than 0.5 cm/hr for a period of 4 hrs after a cervical dilatation of 3 cm.
Three hundred twenty-eight women were randomized to the intervention (n = 163) or usual care (n = 165) groups. Women in the intervention group reported a significantly different pattern of oral intake during early labor in the hospital (chi(2) = 40.7, p
The purpose of this trial was to determine the effectiveness of advanced practice nursing support on cardiac surgery patients' during the first 5 weeks following hospital discharge. Patients ( N = 200) were randomly allocated to two groups: (a) an intervention group who received telephone calls from an advanced practice nurse (APN) familiar with their clinical condition and care needs, twice during the first week following discharge then weekly thereafter for 4 weeks, and (b) a usual care group. Measures of health-related quality of life (HRQL), symptom distress, satisfaction with recovery care, and unexpected health care contacts were obtained at 5 weeks following discharge. There were no significant group differences in HRQL, unexpected contacts with the health care system, or symptom distress. The provision of APN support via telephone followup after cardiac surgery is feasible. However, further randomized trials of single and multicomponent APN interventions are needed to prove effectiveness.
The epidemiology of chronic pain is poorly understood due to a paucity of longitudinal studies limiting the ability to develop prevention strategies for a condition resistant to many current therapies.
To identify the incidence of and sociodemographic risk factors for chronic pain in Canadian women and men over a 12-year period.
Using data from the National Population Health Survey, individuals who developed chronic pain, defined as the presence of "usual pain" were identified. The cumulative incidence of chronic pain was calculated separately for men and women followed from 1994 to 2007. Biannual incidence and prevalence estimates of chronic pain were calculated during the same time period. Logistic regression analysis was used to examine predictors of chronic pain in men and women.
The cumulative incidence over the 12-year period was 35.6% (women 39.0%; men 32.2%). Women had a higher biannual prevalence, but not incidence, of chronic pain compared with men. In women, being older, having lower education and being widowed, separated or divorced, increased the risk of chronic pain. There were no sociodemographic risk factors for chronic pain in men.
Women had a higher prevalence - but not incidence - of chronic pain compared with men, indicative of longer duration of illness in women. Risk factors also differed according to sex, supporting current literature reporting potentially different mechanisms for men and women. A better understanding of risk factors is necessary to develop population-based preventive interventions. The former can only be achieved with population-based, longitudinal studies.
In older persons with heart failure (HF), body composition may influence physical function and treatment effectiveness. There is a lack of research concerning the associations between waist circumference (WC) or body mass index (BMI) and physical function in this population.
To determine whether BMI and WC are associated with physical function in older men and women with HF.
Seventy-one men and 36 women 65 years of age and older living with HF completed two surveys spaced three months apart. Height, weight, WC, time since diagnosis, edema, comorbidities and physical function were self-reported at baseline and follow-up. Physical function was determined using the physical component score of the Short Form-12 and the physical limitation domain (PLD) of the Kansas City Cardiomyopathy Questionnaire. Multivariate linear regression and analysis of covariance were used to evaluate the relationships between WC and BMI, as well as cross-classifications of WC and BMI with physical function, after adjusting for confounders and interactions.
The cross-sectional and short-term follow-up analyses did not detect an association between WC or BMI and physical function, with the exception of changes in the PLD, which were significantly different across WC categories. Persons with a moderate WC experienced the greatest improvement in function. The physical component and PLD scores were lower than those reported by Canadians 75 years of age and older and stable HF patients, respectively. Women reported lower physical function scores than men.
Findings from the present study indicate that older persons with HF, especially women, have poor physical functioning regardless of their WC or BMI.
Cites: J Am Coll Cardiol. 2000 Apr;35(5):1245-5510758967
This study described and compared the sleep experience of medical and surgical patients during a hospital stay. During 3 consecutive nights, patients (n = 110) self-reported sleep quality using the Verran and Snyder Sleep Scale (VSH) and potentially disruptive factors using items from the Factors Influencing Sleep Questionnaire (FISQ). Surgical patients, on the first night, received more procedural care (p = .001), less sedative medication (p
The symptom of pain is not typically associated with heart failure. Yet, emerging evidence suggests that pain is an important issue for this population.
(1) To determine whether pain was reported by a cohort of individuals with heart failure at the time of discharge from hospital, at 2 and 6 weeks postdischarge; (2) To examine the profile of individuals who reported pain at discharge and to determine if there were differences from individuals who did not report pain; (3) To determine whether there was a difference in health-related quality of life between reported pain and no pain groups.
This study was part of a larger randomized controlled trial with a 3-month follow-up. Data were obtained from 169 individuals diagnosed with heart failure who completed the first 6 weeks of the follow-up period.
At time of discharge, 68% of the cohort reported pain. Both frequency and severity of pain fluctuated throughout the study for the entire cohort. There were no sociodemographic characteristics that distinguished those who reported pain from those who did not report pain. Differences in health-related quality of life were found between the reported pain and no pain groups at discharge and week 2. Depression, worry, feeling a loss of control over one's life, and feeling as if one was a burden to family were significantly more prevalent in individuals who reported pain. Differences were also found in self-rated health status, and number of prescription medications taken daily. Throughout the 6 weeks, 63 individuals (37%) consistently reported pain and 23 (14%) never reported pain.
Pain was a concern for this cohort of individuals diagnosed with heart failure and was noted to impact their health-related quality of life. Further research is needed into the nature of the pain and the role of pain in self-management once patients are discharged home.
The objective of this study was to conduct an assessment of supportive care needs from the perspective of parents of children diagnosed with cancer within an urban-rural region in Eastern Ontario, Canada. Guided by a conceptual framework for supportive care, the exploratory, mixed-method study used a standard needs survey and semistructured interviews. Fifteen parents completed (75% response rate) the survey, and 3 parents participated as key informants in the follow-up interview. Parents reported needs in all 6 of the need categories outlined within the Supportive Care Needs Framework. The proportion of parents expressing a need ranged from 23% to 39%. Dealing with the fear of their child's cancer spreading was frequently identified by parents. Emotional and informational needs were the 2 most frequently acknowledged categories of need. With further refinement, the use of the conceptual framework will provide a methodology for planning care based on the individual needs identified by parents of children with cancer.