Musculoskeletal symptoms in self-employed versus employed therapists: the role of training and social support

Introduction The overarching aim for this thesis was to develop a scientific evidence base to assist in the prevention of work-related musculoskeletal disorders (WRMSDs) by investigating the potential risk factors of WRMSDs in both employed and self-employed Chartered Physiotherapists (CPTs) and Physical Therapists/Athletic Therapists (PTs/ATs) in the Irish context and the effectiveness of current risk reduction strategies. Methods The Health In hand-intensive Tasks and Safety (HITS) study was a cross-sectional study investigating WRMSDs in practicing chartered physiotherapists, physical therapists and athletic therapists (n=347). The Survey on Lifestyle, Attitudes and Nutrition (SLÁN) 2007 was a nationally representative survey, with the working population included in this thesis (n=5,862). Results When compared with the national working population, therapists were nearly five times more likely to suffer from low back pain, after careful adjustment for differences in sociodemographics [adjusted OR 4.8, 95% CI (3.8–6.1)] (P<0.001). Self-employed therapists have a higher prevalence of upper limb pain/discomfort (86.6%) compared to employed therapists (76.8%) (P=0.04). Conversely, when it comes to incapacitating upper limb symptoms employed therapists have a higher prevalence (32.7%) compared to self-employed therapists (21.5%) (P=0.04). In relation to upper limb pain/discomfort, supervisor support was seen as protective in employed therapists (P=0.05), however, peer support didn’t indicate any significant findings. On the other hand, low levels of peer support were identified as a risk factor for the prevalence of incapacitating upper limb pain/discomfort in both employed and self-employed therapists (P=0.03 and P≤0.01, respectively). Discussion This thesis indicates that future research needs to focus on both employed and self-employed workers’ health and wellbeing to explicitly examine the effects of work on today’s changing workforce. Further investigation is required in relation to WRMSD prevalence and related factors in employed and self-employed therapists through both qualitative and quantitative methods with the use of more objective measures

Preparedness of Hospitals in the Republic of Ireland for an Influenza Pandemic, an Infection Control Perspective

BACKGROUND: When an influenza pandemic occurs most of the population is susceptible and attack rates can range as high as 40–50 %. The most important failure in pandemic planning is the lack of standards or guidelines regarding what it means to be ‘prepared’. The aim of this study was to assess the preparedness of acute hospitals in the Republic of Ireland for an influenza pandemic from an infection control perspective. METHODS: This was a cross sectional study involving a questionnaire completed by infection control nurses, time period from June – July 2013, (3 weeks) from acute public and private hospitals in the Republic of Ireland. A total of 46 out of 56 hospitals responded to the questionnaire. RESULTS: From a sample of 46 Irish hospitals, it was found that Irish hospitals are not fully prepared for an influenza pandemic despite the 2009 Influenza A (H1N1) pandemic. In 2013, thirty five per cent of Irish hospitals have participated in an emergency plan or infectious disease exercise and have plans or been involved in local planning efforts to care for patients at non-health care facilities. Sixty per cent of Irish hospitals did not compile or did not know if the hospital had compiled a “lessons learned” from any exercise that were then used to revise emergency response plans. Fifty two per cent of hospitals have sufficient airborne isolation capacity to address routine needs and have an interim emergency plan to address needs during an outbreak. Fifty one percent of hospitals have taken specific measures to stockpile or have reserve medical supplies e.g. masks, ventilators and linen. CONCLUSIONS: This is the first study carried out in the Republic of Ireland investigating the current preparedness for an influenza pandemic from an infection control perspective. Deficits exist in the provision of emergency planning committees, testing of emergency plans, airborne isolation facilities, stockpiling of personal protective equipment (PPE) and medical supplies and organisational schemes/incentives for healthcare workers to continue to work in a pandemic. While Irish standards are comparable to findings from international studies, the health care service needs to continue to enhance preparedness for an influenza pandemic and implement standard preparedness guidance for all Irish hospital

The effect of manual handling training on transferring knowledge, employee s behaviour change and subsequent reduction of work-related musculoskeletal disorders: a systematic review

peer-reviewedThis systematic review investigated the effectiveness of manual handling training at transferring knowledge, leading to a positive change in employee’s manual handling behaviour and a reduction of WRMSDs following training. Six electronic databases were searched for randomised controlled trials, non-randomised controlled trials or cohort studies with a control and/or comparison group which investigated the effectiveness of manual handling training. Thirteen articles met the inclusion and exclusion criteria. Following quality assessment, nine of the included articles were found to be high quality. This systematic review suggests that there has been very little research focusing on the effectiveness of manual handling training on transferring knowledge to employee’s and behavioural change. This review indicates that whilst employees report understanding and awareness following training, this does not always lead to the expected behavioural change. This review also suggests it cannot be demonstrated that transferring knowledge to employees will lead to a reduction of WRMSDs.ACCEPTEDpeer-reviewe

Obesity in adults: a 2022 adapted clinical practice guideline for Ireland

This Clinical Practice Guideline (CPG) for the management of obesity in adults in Ireland, adapted from the Canadian CPG, defines obesity as a complex chronic disease characterised by excess or dysfunctional adiposity that impairs health. The guideline reflects substantial advances in the understanding of the determinants, pathophysiology, assessment, and treatment of obesity. It shifts the focus of obesity management toward improving patient-centred health outcomes, functional outcomes, and social and economic participation, rather than weight loss alone. It gives recommendations for care that are underpinned by evidence-based principles of chronic disease management; validate patients' lived experiences; move beyond simplistic approaches of "eat less, move more" and address the root drivers of obesity. People living with obesity face substantial bias and stigma, which contribute to increased morbidity and mortality independent of body weight. Education is needed for all healthcare professionals in Ireland to address the gap in skills, increase knowledge of evidence-based practice, and eliminate bias and stigma in healthcare settings. We call for people living with obesity in Ireland to have access to evidence-informed care, including medical, medical nutrition therapy, physical activity and physical rehabilitation interventions, psychological interventions, pharmacotherapy, and bariatric surgery. This can be best achieved by resourcing and fully implementing the Model of Care for the Management of Adult Overweight and Obesity. To address health inequalities, we also call for the inclusion of obesity in the Structured Chronic Disease Management Programme and for pharmacotherapy reimbursement, to ensure equal access to treatment based on health-need rather than ability to pay

Self-initiated learning reveals memory performance and electrophysiological differences between younger, older and older adults with relative memory impairment

Older adults display difficulties in encoding and retrieval of information, resulting in poorer memory. This may be due to an inability of older adults to engage elaborative encoding strategies during learning. This study examined behavioural and electrophysiological effects of explicit cues to self?initiate learning during encoding and subsequent recognition of words in younger adults (YA), older control adults (OA) and older adults with relative memory impairment (OD). The task was a variation of the old/new paradigm, some study items were preceded by a cue to learn the word (L) while others by a do not learn cue (X). Behaviourally, YA outperformed OA and OD on the recognition task, with no significant difference between OA and OD. Event?related potentials at encoding revealed enhanced early visual processing (70?140 ms) for L? versus X?words in young and old. Only YA exhibited a greater late posterior positivity (LPP; 200?500 ms) for all words during encoding perhaps reflecting superior encoding strategy. During recognition, only YA differentiated L? versus X?words with enhanced frontal P200 (150?250 ms) suggesting impaired early word selection for retrieval in older groups; however, OD had enhanced P200 activity compared to OA during L?word retrieval. The LPP (250?500 ms) was reduced in amplitude for L?words compared to both X? and new words. However, YA showed greater LPP amplitude for all words compared to OA. For older groups, we observed reduced left parietal hemispheric asymmetry apparent in YA during encoding and recognition, especially for OD. Findings are interpreted in the light of models of compensation and dedifferentiation associated with age?related changes in memory function