European Working Time Directive and doctors' health: a systematic review of the available epidemiological evidence

Objective: To summarise the available scientific evidence on the health effects of exposure to working beyond the limit number of hours established by the European Working Time Directive (EWTD) on physicians. Design: A systematic literature search was conducted in PubMed and EMBASE. Study selection, quality appraisal and data extraction were carried out by independent pairs of researchers using pre-established criteria. Setting: Physicians of any medical, surgical or community specialty, working in any possible setting (hospitals, primary healthcare, etc), as well as trainees, residents, junior house officers or postgraduate interns, were included. Participants: The total number of participants was 14 338. Primary and secondary outcome measures: Health effects classified under the International Classification of Diseases (ICD-10). Results: Over 3000 citations and 110 full articles were reviewed. From these, 11 studies of high or intermediate quality carried out in North America, Europe and Japan met the inclusion criteria. Six studies included medical residents, junior doctors or house officers and the five others included medical specialists or consultants, medical, dental, and general practitioners and hospital physicians. Evidence of an association was found between percutaneous injuries and road traffic accidents with extended long working hours (LWH)/days or very LWH/weeks. The evidence was insufficient for mood disorders and general health. No studies on other health outcomes were identified. Conclusions: LWH could increase the risk of percutaneous injuries and road traffic accidents, and possibly other incidents at work through the same pathway. While associations are clear, the existing evidence does not allow for an established causal or ‘dose–response’ relationship between LWH and incidents at work, or for a threshold number of extended hours above which there is a significantly higher risk and the hours physicians could work and remain safe and healthy. Policymakers should consider safety issues when working on relaxing EWTD for doctors

Pudendusneuralgie: Anatomisch-chirurgische Aspekte

Zusammenfassung: Anatomie:: Das Perineum wird hauptsächlich von den Nervi pudendi versorgt. Der Nervus pudendus, ein tiefliegender Dammnerv, durchläuft mehrere Zonen, in denen Kompressionen auftreten können: zwischen dem Ligamentum supraspinatum und dem Ligamentum sacrococcygeum, zwischen dem Ligamentum sacrotuberale und dem Ligamentum sacrospinale, im Alcock-Kanal sowie im Bereich des Musculus obturatorius internus. Eine derartige Kompression kann zu einem Schmerzsyndrom im Dammbereich führen. Symptome:: Klinisch äußert sich die Kompression des Nervus pudendus durch neurologische Symptome einer Nervenkompression. Derartige Kompressionen können zu schwer diagnostizierbaren Schmerzzuständen führen. Brennende Schmerzen im Dammbereich, die eindeutig dem Versorgungsgebiet des Nervus pudendus zugeordnet werden können, im Sitzen verstärkt und einseitig auftreten, müssen an eine Kompression des Nervus pudendus denken lassen. Diagnose:: Die Diagnose stützt sich auf Anamnese und Klinik. Elektrophysiologische und bildgebende Untersuchungen dienen dem Ausschluss anderer Pathologien. Die diagnostische Infiltration des Canalis pudendalis kann in 30-40% der Fälle therapeutisch sein. Ein chirurgischer Eingriff zur Dekompression ist in 65-70% der Fälle erfolgreich. Da die Besserung oft nicht sofort eintritt, müssen die Patienten über diese Tatsache präoperativ informiert werden. Eine multidisziplinäre Betreuung ist unerlässlic

Optimizing electrode implantation in sacral nerve stimulation—an anatomical cadaver study controlled by a laparoscopic camera

Background and aim: Sacral nerve stimulation is the therapy of choice in patients with neurogenic faecal and urine incontinence, constipation and some pelvic pain syndromes. The aim of this study is to determine the best insertion angles of the electrode under laparoscopic visualization of the sacral nerves. Materials and methods: Five fresh cadaver pelvises were dissected through an anterior approach of the presacral space, exposing the ventral sacral roots. Needles and electrodes were inserted into the S3 foramen. Both right and left sides were used, with the traditional percutaneous procedure. The validation was done by a laparoscopic camera controlling the position of the needle and electrode on the nerve. The angles were assessed with a goniometer and were confirmed in two living patients. Results: The mean angle of insertion in the sagittal plane was 62.9 ± 3° (range, 59-70). In the axial plane, the mean angle for the left side was 91.7 ± 13.5° (range, 80-110) and 83.2 ± 7.7° for the right side (range, 75-95). These angles resulted in the optimal placement of the leads along the S3 sacral root, in all these cases. Conclusions: This study allows direct visualization during the placement of the needle and electrode, thus permitting accurate calculations of the best angle of approach during the surgical procedure in sacral nerve stimulation. These objective findings attempt to standardize this technique, which is often performed with the aid of intra-operative fluoroscopy but still leaving a lot to chance. These insertion angles should help to find more consistent and reproducible results and thus improved outcome in patient

Assessing the potential influence of the biofilter’s microbiota on the bacterial communities of the rearing water in small-scale RAS with Atlantic salmon fry

Integreringen av RAS i produksjonssyklusen til atlantisk laks vokser fordi det reduserer vannforbruket og gir et relativt stabilt og kontrollert kulturmiljø. I RAS resirkuleres vann etter å ha gjennomgått en behandlingsprosess, hvor et nitrifiserende biofilter spiller en avgjørende rolle. Det nitrifiserende biofilteret huser komplekse bakteriesamfunn, som utgjør den største populasjonen av bakterier i et RAS. Imidlertid er det dårlig forstått i hvilken grad disse samfunnene påvirker mikrobiotaen til oppdrettsvannet, til tross for potensielle implikasjoner for fiskens ytelse. Vi gjennomførte en to-måneders studie for å undersøke den potensielle påvirkningen av mikrobiotaen til biofilterets biofilm på mikrobiotaen til oppdrettsvannet i et RAS med atlantisk lakseyngel. Atlantisk lakseyngel ble oppdrettet i to laboratorieskala RAS der biofiltrene ble lastet med biofilmbærere hentet fra to forskjellige geografiske lokasjoner (Belsvik og Kjærelva). På dag_21 av eksperimentet ble biofilmbærerne byttet mellom systemer og eksperimentet fortsatte i ytterligere 21 dager. Vann- og biofilmmikrobiotene ble karakterisert ved tre tidspunkter ved 16S rRNA-genamplikonsekvensering. Fiskevelferden var god, noe som indikeres av lave dødelighetsprosent og optimale vannkvalitetsparametere. PCR-produkter ble vellykket amplifisert fra både vann- og biofilmprøver etter optimalisering av malkonsentrasjonen. Distinkte bakteriesamfunn ble observert i biofilmbærerne fra de to stedene. Deinococcales, med en dominerende ASV klassifisert som Deinococcus, var begrenset til mikrobiotaen til Belsvik-bærere, mens Nitrospirales var svært rikelig i både Belsvik- og Kjærelva-bærere. Vannsamfunnene i begge systemene ble dominert av Burkholderiales, Micrococcales, Flavobacteriales og Rhodobacterale. Selv om vannmikrobiotaen til de to RAS var betydelig ulik på alle tidspunkter, var det en økt likhet på Day_42, 21 dager etter bytte av biofiltre mellom systemene. Vi fant betydelige forskjeller mellom vann- og biofilmsamfunnene i hver RAS til enhver tid. En ASV som tilhører slekten Auantimicrobium, bidro mest til forskjellene mellom mikrobiotaen til vannet og biofilterets biofilm. Denne slekten ble utelukkende funnet i vannet, mens den var fraværende i biofilmen. På den annen side var ASV-er som representerte Nitrospira mer rikelig i biofilmen sammenlignet med vannet. Til tross for de betydelige forskjellene mellom mikrobiotaen til oppdrettsvannet og biofilterets biofilm, var et betydelig antall ASV-er tilstede i både vann- og biofilmmikrobiotaen. Den gjennomsnittlige Bray-Cutis-likheten var signifikant høyere når man sammenligner vannmikrobiotaen med biofilmmikrobiotaen til samme RAS, enn når man sammenligner vannmikrobiotaen til en RAS med biofilmmikrobiotaen til den andre RASen på samme prøvetakingstidspunkt. Når bærerne ble utvekslet mellom systemene, ble vannmikrobiotaen mer lik mikrobiotaen til de nye biofilmbærerne introdusert i systemet sammenlignet med den forrige biofilmmikrobiotaen. Dermed påvirket bakteriesamfunnene i biofilteret i betydelig grad de i oppvekstvannet. Disse funnene forbedrer vår forståelse av forholdet mellom biofilmen og vannmikrobiotaen. I tillegg tyder disse resultatene på at bakterier som stammer fra biofilteret kan samhandle med fiskens slimhinneoverflater og dermed påvirke fiskens ytelse i et RAS. Derfor gjenstår det å studere bruken av disse funnene i håndteringen av mikrobiell vannkvalitet.The integration of RAS in the production cycle of Atlantic salmon is growing because it reduces water consumption and provides a relatively stable and controlled culture environment. In RAS, water is recycled after undergoing a treatment process, where a nitrifying biofilter plays a crucial role. The nitrifying biofilter harbors complex bacterial communities, which make up the biggest population of bacteria in a RAS. However, the extent to which these communities influence the microbiota of the rearing water is poorly understood, despite the potential implications for fish performance. We conducted a two-month study to investigate the potential influence of the microbiota of the biofilter’s biofilm on the microbiota of the rearing water in a RAS with Atlantic salmon fry. Atlantic salmon fry was reared in two lab-scale RAS in which the biofilters were loaded with biofilm carriers sourced from two different geographical locations (Belsvik and Kjærelva). On Day_21 of the experiment, the biofilm carriers were swapped between systems and the experiment continued for another 21 days. The water and biofilm microbiotas were characterized at three time points by 16S rRNA gene amplicon sequencing. The fish welfare was good, as indicated by low mortality percentages and optimal water quality parameters. PCR products were successfully amplified from both water and biofilm samples after optimization of the template concentration. Distinct bacterial communities were observed in the biofilm carriers from the two locations. Deinococcales, with a dominant ASV classified as Deinococcus, was limited to the microbiota of Belsvik carriers, while Nitrospirales was highly abundant in both Belsvik and Kjærelva carriers. The water communities of both systems were dominated by Burkholderiales, Micrococcales, Flavobacteriales, and Rhodobacterale. Although the water microbiota of the two RAS was significantly dissimilar at all time points, there was an increased similarity on Day_42, 21 days after the switching the biofilters between the systems. We found significant differences between the water and biofilm communities in each RAS at all time points. An ASV belonging to the genus Aurantimicrobium, contributed the most to the differences between the microbiota of the water and the biofilter’s biofilm. This genus was exclusively found in the water, while it was absent in the biofilm. On the other hand, ASVs representing Nitrospira were more abundant in the biofilm compared to the water. Despite the significant differences between the microbiota of the rearing water and the biofilter’s biofilm, a significant number of ASVs were present in both the water and biofilm microbiota. The average Bray-Cutis similarity was significantly higher when comparing the water microbiota with the biofilm microbiota of the same RAS, than when comparing the water microbiota of one RAS with the biofilm microbiota of the other RAS at the same sampling time. Once the carriers were exchanged between systems, the water microbiota became more similar to the microbiota of the new biofilm carriers introduced into the system compared to the previous biofilm microbiota. Thus, the bacterial communities of the biofilter significantly influenced those of the rearing water. These findings improve our understanding of the relationship between the biofilm and water microbiota. In addition, these results suggest that bacteria originating from the biofilter may interact with the fish mucosal surfaces and thereby influence fish performance in a RAS. Therefore, the application of these findings in the management of microbial water quality remains to be studied

How musical selection impacts the performance of the interaction with the computer

In this busy society of ours people push their limits to work better and more in order to remain competitive with their peers. Nonetheless, working longer hours does not necessarily improves productivity nor performance. In order to prevent the negative consequences of this increasing trend, the evolution of performance throughout the day of work should be more closely monitored. This could avoid undesirable states or even breakdowns, which have social and economical implications. In this work we measure user performance through their interaction with the computer. We monitor its evolution during a day of work and how di erent types of music may increase or decrease its natural daily degradation. We conclude that the relationship between types of music and its e ects is not universal and depends, among other things, on the musical pro le of the individual. A prototype for a distributed music recommendation service is presented that suggests musics at an individual and group level, based on user musical pro les and objectives.This work is part-funded by ERDF - European Regional Development Fund through the COMPETE Programme (operational programme for competitiveness) and by National Funds through the FCT - Fundação para a Ciência e a Tecnologia (Portuguese Foundation for Science and Technology) within project FCOMP-01-0124-FEDER-028980 (PTDC/EEI-SII/1386/2012)

Social Innovation and Social Enterprise: Integrating Mental Health Interventions

An estimated 450 million people suffer from a mental or behavioural disorder. According to WHO’s Global Burden of Disease 2001, 3% of the years lived with disability (YLD) are due to neuropsychiatric disorders, a further 2.1% to intentional injuries (WHO, 2013). Only 1% of the medical doctors and 4% of the nurses were specialized in psychiatry. The last revision of the mental health legislation was in 1964. The legislation basically focused on the custodial care of the mentally ill persons and is an antiquated kind of law that has been overtaken by events. One percent (1%) of health care expenditures by the government health department was specifically directed towards mental health in primary care. Despite developing Uganda\u27s mental health policy in 2000, it was still at draft level. The policy included the following components: (1) developing community mental health services, (2) downsizing large mental hospitals, (3) developing a mental health component in primary healthcare, (4) human resources, (5) involvement of users and their families, (6) advocacy and promotion, (7) human rights protection of users, (8) equity of access to mental health services across different groups, (9) Monitoring system. Of the overall expenditure on mental health, 55% was directed towards the National Mental Hospital. The whole population (100%) had free access (of at least 80%) to essential psychotropic medicines. This is based on the fact that medication is provided at no cost in all public health facilities. For those who pay out of pocket, 37% of the daily minimum wage was needed to pay for one day antipsychotic medication, while 7% of daily wage was needed to pay for one day dose of antidepressant medication. Mental disorders were not covered in the current social insurance schemes (WHO, 2013). Moreover, goal three (3) of the Sustainable Development Goals was good health and wellness

Communal pastoral counselling : culturally gifted care-giving in times of family pain - a vhavenda perspective

The thesis argues that there is a need for Christian communal pastoral care and counselling practice beyond the individualistic Western pastoral care and counselling practices. The communal pastoral care model advocated by the author uses culturally gifted care-givers who follow spontaneous caring models. Several of the major books concerning communal pastoral care and counselling were reviewed. The author concludes that the church has been impoverished by ignoring the cultural gifts of the majority of members and the mutual communal care of the community. Pain and its healing in this thesis are understood in a culturally sensitive manner. Pastoral care must be done in context, in this case in the Vhavenda context. Hence the thesis looks systematically at the way in which the Vhavenda understand and heal pain from their cosmological perspective. The thesis engages in empirical research among the Vhavenda people using qualitative interview. The author selected five small communities to test for their understanding of pain and healing. He developed his own interview schedule. Themes encountered in interpreting the research results include pain as part of life. The thesis develops two sub-models of a Vhavenda-Christian culturally gifted model of communal care arguing the need of their incorporation into Christian communal care. They are “Kha ri vangulane” model which pictures pain as a thorn which people help to remove from a person; and the “khoro” or “dzulo” gathering which is family or community care-giving. A case study has illustrated how they are used.Finally, the author argues that the Bible is full of communal pictures which resonate well with the African people. Hence it is fairly easy to correlate the Vhavenda sense of community with the body of Christ model of Christian community as found in the Bible. The conclusion is that members of the Christian community need to reincorporate their culturally gifted care resources and integrate them with the biblical care.Thesis (D. Th. (Practical Theology)

Assessing Objective and Verifiable Indicators Associated With Work-Related Stress: Validation of a Structured Checklist for the Assessment and Management of Work-Related Stress

Risk assessment represents an essential part of any successful intervention in health and safety at work. The most prominent European methodologies propose multi-method approaches for identifying the risks associated with work-related stress. Nevertheless, the most widely used method is the self-administered questionnaire. By adapting the UK Management Standards approach, the Italian National Workers Compensation Authority (INAIL) developed a checklist for the assessment of objective and verifiable indicators of work-related stress. This checklist is filled in by a steering group composed of homogenous groups of workers. Through a web-platform developed by INAIL, a considerable amount of data over the last 5 years has been collected throughout Italy. The aims of this study are to examine the psychometric properties as well as the practical validity of the checklist in a wide sample of Italian companies. The sample comprised 5,301 homogeneous groups of workers nested within 1,631 organizations. The checklist measures two main areas: (1) the organizational indicators of work-related stress (sentinel events) and (2) four and six factors related respectively to content and context of work. Multilevel and multivariate analyses revealed that the checklist shows adequate factor structure and criterion validity. Results also demonstrate that small companies and the public and healthcare sector show higher risk levels. These results support the use of the checklist as a structured and generalizable tool for assessing and monitoring the risks associated with work-related stress