2012-05-01 12:00 - Messages

Bilan des connaissances sur les guides de pratique en santé

Enseignements clés et transférabilité pour la santé et la sécurité au travail.
Les guides de pratique sont vus comme un moyen d'organiser et d'accélérer le transfert des connaissances. On estime qu'on publie dans le monde, à chaque année, 10 000 guides de pratique de toutes sortes. D'après une étude récente, près d'un tiers des chercheurs canadiens en santé et sécurité du travail (SST) avaient participé à l'élaboration d'un guide, au cours des cinq dernières années.
Les responsables de cette recherche ont effectué une revue des écrits sur les guides de pratique clinique afin d'en tirer les enseignements clés et de voir ce qui pourrait être transférable au domaine de la SST. Ce choix s'explique par la très grande abondance de projets menés sur les guides de pratique en santé et d'écrits publiés sur le sujet au cours des 25 dernières années. Une base de données sur les guides publiés en français en SST qui peuvent être téléchargés gratuitement a été constituée et rendue disponible sur le site Web du Réseau de recherche en SST du Québec.

Source : http://www.irsst.qc.ca/-publication-irsst-bilan-des-connaissances-sur-les-guides-de-pratique-en-sante-enseignements-cles-et-transferabilite-sante-securite-au-travail-r-736.html

Occupational lifting and pelvic pain during pregnancy

A study within the Danish National Birth Cohort
Objectives : Pelvic pain during pregnancy is a common ailment, and the disease is a major cause of sickness absence during pregnancy. It is plausible that occupational lifting may be a risk factor of pelvic pain during pregnancy, but no previous studies have examined this specific exposure. The aim of this study was to examine the association between occupational lifting and pelvic pain during pregnancy.
Methods : The study comprised 50 143 pregnant women, enrolled in the Danish National Birth Cohort in the period from 1996–2002. During pregnancy, the women provided information on occupational lifting (weight load and daily frequency), and six months post partum on pelvic pain. Adjusted odds ratios for pelvic pain during pregnancy according to occupational lifting were calculated by logistic regression.
Results : Any self-reported occupational lifting (>1 time/day and loads weighing >10 kg) was associated with an increased risk of pelvic pain during pregnancy as compared to no such lifting. A confounder-adjusted exposure-response relation was observed between self-reported total loads lifted and pelvic pain during pregnancy. Daily lifting of both medium (11–20 kg) and heavy loads (>20 kg) were associated with increased risk, and the highest risk was observed among women who lifted heavy loads independent of exposure to medium loads.
Conclusion : Occupational lifting may increase the risk of pelvic pain during pregnancy.

Source : Larsen P, Strandberg-Larsen K, Juhl M, Svendsen SW, Bonde JP, Nybo Andersen A-M. Scand J Work Environ Health. 2012.
http://dx.doi.org/10.5271/sjweh.3304

Psychosocial precursors and physical consequences of workplace violence towards nurses

A longitudinal examination with naturally occurring groups in hospital settings
BACKGROUND: Workplace violence towards nurses is prevalent and consequential, contributing to nurses' reduced health and safety, worsened job attitudes, and compromised productivity. OBJECTIVES: To examine if organizational violence prevention climate as perceived by nurses predicts nurses' physical violence exposure and if physical violence exposure predicts nurses' somatic symptoms and musculoskeletal disorder symptoms. DESIGN: A two-wave longitudinal design with naturally occurring groups, with a 6-month interval. METHODS: Analysis of covariance and logistic regression were applied to test the proposed hypotheses among 176 nurses from two hospitals in the U.S. who participated in both surveys required by this study. All nurses from the two hospitals were recruited to participate voluntarily. The response rate was 30% for the first survey and 36% for the follow-up survey. Among the subjects, only 8 were male. On average, the subjects were about 45 years old, had a job tenure of about 17 years, and worked approximately 37h per week. RESULTS: Violence prevention climate, specifically the dimension of perceived pressure against violence prevention, predicted nurses' chance of being exposed to physical violence over six months (odds ratio 1.69), with no evidence found that violence exposure affected change in climate reports. In addition, results supported that nurses' physical violence exposure had effects on somatic symptoms, and upper body, lower extremity, and low back pain over six months. CONCLUSIONS: Findings of this study suggest that reducing organizational pressure against violence prevention will help decrease the chance of nurses' physical violence exposure and benefit their health and safety.

Source : Yang LQ, Spector PE, Chang CH, Gallant-Roman M, Powell J. Int. J. Nurs. Stud. 2012.
http://dx.doi.org/10.1016/j.ijnurstu.2012.03.006

Individual participant data meta-analysis of mechanical workplace risk factors and low back pain

Objectives. We used individual participant data from multiple studies to conduct a comprehensive meta-analysis of mechanical exposures in the workplace and low back pain.
Methods. We conducted a systematic literature search and contacted an author of each study to request their individual participant data. Because outcome definitions and exposure measures were not uniform across studies, we conducted 2 substudies: (1) to identify sets of outcome definitions that could be combined in a meta-analysis and (2) to develop methods to translate mechanical exposure onto a common metric. We used generalized estimating equation regression to analyze the data.
Results. The odds ratios (ORs) for posture exposures ranged from 1.1 to 2.0. Force exposure ORs ranged from 1.4 to 2.1. The magnitudes of the ORs differed according to the definition of low back pain, and heterogeneity was associated with both study-level and individual-level characteristics.
Conclusions. We found small to moderate ORs for the association of mechanical exposures and low back pain, although the relationships were complex. The presence of individual-level OR modifiers in such an area can be best understood by conducting a meta-analysis of individual participant data.

Source : http://www.iwh.on.ca/biblio/individual-participant-data-meta-analysis-of-mechanical-workplace-risk-factors-and-low-back

A systematic review and meta-analysis of efficacy, cost-effectiveness, and safety of selected complementary and alternative medicine for neck and low-back pain

Background. Back pain is a common problem and a major cause of disability and health care utilization. Purpose. To evaluate the efficacy, harms, and costs of the most common CAM treatments (acupuncture, massage, spinal manipulation, and mobilization) for neck/low-back pain. Data Sources. Records without language restriction from various databases up to February 2010. Data Extraction. The efficacy outcomes of interest were pain intensity and disability. Data Synthesis. Reports of 147 randomized trials and 5 nonrandomized studies were included. CAM treatments were more effective in reducing pain and disability compared to no treatment, physical therapy (exercise and/or electrotherapy) or usual care immediately or at short-term follow-up. Trials that applied sham-acupuncture tended towards statistically nonsignificant results. In several studies, acupuncture caused bleeding on the site of application, and manipulation and massage caused pain episodes of mild and transient nature. Conclusions. CAM treatments were significantly more efficacious than no treatment, placebo, physical therapy, or usual care in reducing pain immediately or at short-term after treatment. CAM therapies did not significantly reduce disability compared to sham. None of the CAM treatments was shown systematically as superior to one another. More efforts are needed to improve the conduct and reporting of studies of CAM treatments.

Source : http://www.iwh.on.ca/biblio/a-systematic-review-and-meta-analysis-of-efficacy-cost-effectiveness-and-safety-of-selected
 

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