Human factors evaluation of surgeons’ working positions for gynecologic minimal access surgery

Study Objective: To investigate work-related musculoskeletal disorders (WRMSD) in gynaecological minimal access surgery (MAS), including bariatric (plus size) patients. Design: Mixed methods Design classification: Level III (descriptive and qualitative) Setting: UK Teaching Hospital Patients: Not applicable Interventions: Not applicable Measurements: Survey, observations (anthropometry, postural analysis) and interviews. Results: WRMSD were present in 63% of survey respondents (n=67). The pilot study (n=11) identified contributory factors including workplace layout, equipment design and preference of port use (relative to patient size). Statistically significant differences for WRMSD-related posture risks were found within groups (average size mannequin and plus size mannequin) but not between patient size groups suggesting that port preference may be driven by surgeon preference (and experience) rather than patient size. Conclusion: Some of the challenges identified in this project need new engineering solutions to allow flexibility to support surgeon choice of operating approach (open, laparoscopic or robotic) with a work place which supports adaptation to the task, surgeon and patient

Save our surgeons: an ergonomics evaluation of laparoscopic hysterectomy

This paper presents an investigation of ergonomic issues and coping strategies during gynaecological laparoscopic surgery. Data were collected with questionnaires, postural analysis and interviews. The results suggest that work-related musculoskeletal disorders were present in almost 90% of survey respondents. The workplace factors included equipment dimensions, preference of port positioning and patient size with limited adjustability for all surgeons to perform comfortably and effectively. These findings have implications for service provision (availability of surgeons) and patient safety (human interface design)

How well do waist circumference and body mass index reflect body composition in pre-pubertal children?

Objective: To investigate the quantitative relationship between WC and height and subsequently the association between Waist Circumference Index (WCI), BMI, and body composition in pre-pubertal children. Design: Cross-sectional sample (n = 227; boys = 127) of pre-pubertal Black children (age range 8.8 to 11.0 years) from the Bone Health sub-study of the Bt20 birth cohort study set in Soweto-Johannesburg, South Africa. Measures of height, weight, and waist circumference by anthropometry, total and truncal fat and lean mass by Dual-energy X-ray Absorptiometry (DXA) were used in the analysis. Pearson’s correlation coefficients were used to examine the associations between BMI, WC, and body composition outcomes. Results: WC was independent of height when height was raised to a power of approximately 0.8. BMI and WCI (WC/Ht) were significantly associated with total and truncal fat and lean mass in both sexes (all P < 0.001). BMI demonstrated consistently and significantly higher correlations with body composition than WCI and this association was significantly greater for fat mass than lean mass. Conclusion: BMI, rather than WCI, would be a better screening tool for total and truncal fat mass in both sexes prior to puberty

Is puberty starting earlier in urban South Africa?

Age at the initation of pubertal development was estimated for 401 Black (212 boys) and 206 White (100 boys) urban South African adolescents born in Soweto-Johannesburg in 1990. Average age at the initation of puberty, assessed by age at the transition from Tanner stage 1 to Tanner stage 2 for breast/genitalia or pubic hair development ranged between 9.8 and 10.5 years. There were no statistically significant differences in age at initiation between genders or ethnic groups. Age at the initation of pubertal development has remained stable over the last 10 to 15 years, with the exception of pubic hair in boys which has declined on average 1.3 years over a decade. There is evidence to suggest that the tempo of pubertal maturation is increasing in girls born in the Soweto-Johannesburg area, however, the evidence is less clear for boys

Age at menarche and the evidence for a positive secular trend in urban South Africa

Menarcheal age was estimated for 287 (188 Black; 99 White) urban South African girls born in Soweto-Johannesburg in 1990. The median menarcheal age for Blacks was 12.4 years (95% confidence interval [CI] 12.2, 12.6) and 12.5 years (95% CI 11.7, 13.3) for Whites. Data from six studies of menarcheal age, including the current study, were analyzed to examine the evidence for a secular trend between 1956 and 2004 in urban South African girls. There was evidence of a statistically significant secular trend for Blacks, but not Whites. Average menarcheal age for Blacks decreased from 14.9 years (95% CI 14.8, 15.0) in 1956 to 12.4 years (95% CI 12.2, 12.6) in the current study, an average decline of 0.50 years per decade. Fewer data were available for Whites, but average menarcheal age decreased from 13.1 years (95% CI 13.0, 13.2) in 1977 to 12.5 years (95% CI 11.7, 13.3) in the current study, an average decline of 0.22 years per decade. The diminishing age at menarche and the current lack of difference between Blacks and Whites is probably reflective of the continuing nutritional and socio-economic transition occurring within South Africa

A comparison of the socio-economic determinants of growth retardation in South African and Filipino infants

Objective: To examine the association between household socio-economic status (SES) at birth and poor infant growth such as small for gestational age (SGA) and stunting across two different socio-cultural settings: South Africa and the Philippines. Design: Data were from two longitudinal birth cohorts, the Birth to Twenty (Bt20) study in South Africa and the Cebu Longitudinal Health and Nutrition Survey (CLHNS) in the Philippines. Subjects: Bt20 infants (n 2293 total; reduced to 758 (SGA), 450 (stunting 1 year) and 401 (stunting 2 years)) and CLHNS infants (n 2513 total; reduced to 2161 (SGA), 1820 (stunting 1 year) and 1710 (stunting 2 years)). Results: CLHNS infants were significantly more likely to be born SGA (20.9 v. 11.7%) and be stunted at 1 year (32.6 v. 8.7%) and 2 years (48.9 v. 21.1%) compared with Bt20 infants. Logistic regression analyses showed that SES (index) was a significant predictor of stunting at 1 and 2 years of age in the CLHNS cohort. SES (index or individual variables) was not a significant predictor of SGA in either cohort, or of stunting in the Bt20 cohort. Maternal education, ownership of a television and toilet facilities were all independent predictors of stunting in the CLHNS cohort. Conclusions: The social and economic milieu within the Philippines appears to place CLHNS infants at greater risk of being born SGA and being stunted compared with Bt20 infants. The present research highlights the importance of investigating the individual SES variables that predict infantile growth faltering, to identify the key areas for context-specific policy development and intervention