What makes a moving and handling people guideline work? : a thesis presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Public Health at Massey University, Manawatū, New Zealand

Appendix 2 was removed to comply with copyright, but it may be accessed via: Lidegaard, M., Olsen, K.B., and Legg, S.J. (2019, April ). How was a national moving and handling people guideline intended to work? The underlying programme theory. Evaluation and Program Planning, 73, 163–75. https://doi.org/10.1016/j.evalprogplan.2019.01.002Moving and handling of people (MHP) is a major reason for developing musculoskeletal disorders (MSD) in the healthcare sector worldwide. To reduce MSD from MHP, many national and state level guidelines targeting MHP have been developed. However, little is known about their impact on injury claims rates, how they are intended to work, if intended users are aware of and use them, which parts of the guideline are being used, and how they are implemented. Therefore, the overarching goal of this thesis was to contribute to understanding what makes a MHP guideline work. It was addressed by examining the effects of introducing the New Zealand Accident Compensation Corporation ‘Moving and Handling People: The New Zealand Guidelines’ (MHPG), using a mixed-methods approach in five sequential studies. An analysis of claims data (Study 1) showed that MHP related claims rates declined before, but increased after the introduction of the MHPG. A study of the MHPG programme theory (Study 2) showed that key actors for implementation were MHP coordinators, H&S managers, and therapists. The developers argued for implementing a multifaceted MHP programme where implementation of organisational systems should create the foundation for implementing the core components. A questionnaire analysis (Study 3) showed that a high proportion of MHP coordinators, H&S managers, and therapists were aware of the MHPG, while a high proportion of therapists used it. In contrast, fewer carers were aware of and used it. A second questionnaire analysis (Study 4) showed that more key actors were familiar with and used the core components compared to the organisational systems. A low proportion of actors experienced change after use. Case studies (Study 5) showed that organisational motivation to implement a MHP programme was initiated by MHP related staff injuries. The implementation process was gradual, changing MHP practices during multiple steps, and dependent on a dedicated person to drive implementation. This thesis shows that making a MHP guideline work requires a dedicated actor, with support from management, to facilitate implementation and organisational changes needed. However, many contextual factors affect implementation, ranging from national, e.g. legislation and policies, to individual level, e.g. individuals conducting MHP

The relation of ambulatory heart rate with all-cause mortality among middle-aged men : a prospective cohort study

The aim of this study was to investigate the association between average 24-hour ambulatory heart rate and all-cause mortality, while adjusting for resting clinical heart rate, cardiorespiratory fitness, occupational and leisure time physical activity as well as classical risk factors. A group of 439 middle-aged male workers free of baseline coronary heart disease from the Belgian Physical Fitness Study was included in the analysis. Data were collected by questionnaires and clinical examinations from 1976 to 1978. All-cause mortality was collected from the national mortality registration with a mean follow-up period of 16.5 years, with a total of 48 events. After adjustment for all before mentioned confounders in a Cox proportional hazards regression analysis, a significant increased risk for all-cause mortality was found among the tertile of workers with highest average ambulatory heart rate compared to the tertile with lowest ambulatory heart rate (Hazard ratio = 3.21, 95% confidence interval: 1.22-8.44). No significant independent association was found between resting clinic heart rate and all-cause mortality. The study indicates that average 24-hour ambulatory heart rate is a strong predictor of all-cause mortality independent from resting clinic heart rate, cardiorespiratory fitness, occupational and leisure time physical activity and other classical risk factors among healthy middle-aged workers.SCOPUS: ar.jinfo:eu-repo/semantics/publishe

Long Term Effects on Risk Factors for Cardiovascular Disease after 12-Months of Aerobic Exercise Intervention:A Worksite RCT among Cleaners

<div><p>Objectives</p><p>Occupational groups exposed to high occupational physical activity have an increased risk for cardiovascular disease (CVD). This may be explained by the high relative aerobic workload. Enhanced cardiorespiratory fitness reduces the relative aerobic workload. Thus, the aim was to evaluate the 12-months effects of worksite aerobic exercise on risk factors for CVD among cleaners.</p><p>Methods</p><p>One hundred and sixteen cleaners aged 18–65 years were randomized to a group performing aerobic exercise and a reference group receiving lectures. Outcomes were collected at baseline and after 12-months. A repeated measures 2×2 multi-adjusted mixed-model design was applied to compare the between-group differences using intention-to-treat analysis.</p><p>Results</p><p>Between-group differences (<i>p</i><0.05) were found favouring the aerobic exercise group: cardiorespiratory fitness 2.15 (SE 1.03) mlO₂/min/kg, aerobic workload -2.15 (SE 1.06) %HRR, resting HR -5.31 (SE 1.61) beats/min, high sensitive C-reactive protein -0.65 (SE 0.24) μg/ml. The blood pressure was unaltered. Stratified analyses on relative aerobic workload at baseline revealed that those with relative aerobic workloads ≥30% of HRR seems to impose a notable adverse effect on resting and ambulatory blood pressure.</p><p>Conclusion</p><p>This long-term worksite aerobic exercise intervention among cleaners led to several beneficial effects, but also potential adverse effects among those with high relative aerobic workloads.</p><p>Trial Registration</p><p>Controlled-Trials.com <a href="http://www.controlled-trials.com/ISRCTN86682076" target="_blank">ISRCTN86682076</a></p></div

Expert consensus document: Clinical and molecular diagnosis, screening and management of Beckwith-Wiedemann syndrome: an international consensus statement.

Beckwith-Wiedemann syndrome (BWS), a human genomic imprinting disorder, is characterized by phenotypic variability that might include overgrowth, macroglossia, abdominal wall defects, neonatal hypoglycaemia, lateralized overgrowth and predisposition to embryonal tumours. Delineation of the molecular defects within the imprinted 11p15.5 region can predict familial recurrence risks and the risk (and type) of embryonal tumour. Despite recent advances in knowledge, there is marked heterogeneity in clinical diagnostic criteria and care. As detailed in this Consensus Statement, an international consensus group agreed upon 72 recommendations for the clinical and molecular diagnosis and management of BWS, including comprehensive protocols for the molecular investigation, care and treatment of patients from the prenatal period to adulthood. The consensus recommendations apply to patients with Beckwith-Wiedemann spectrum (BWSp), covering classical BWS without a molecular diagnosis and BWS-related phenotypes with an 11p15.5 molecular anomaly. Although the consensus group recommends a tumour surveillance programme targeted by molecular subgroups, surveillance might differ according to the local health-care system (for example, in the United States), and the results of targeted and universal surveillance should be evaluated prospectively. International collaboration, including a prospective audit of the results of implementing these consensus recommendations, is required to expand the evidence base for the design of optimum care pathways

Is aerobic workload positively related to ambulatory blood pressure?: a cross-sectional field study among cleaners

Cardiovascular disease is prevalent among workers with high levels of occupational physical activity. The increased risk may be due to a high relative aerobic workload, possibly leading to increased blood pressure. However, studies investigating the relation between relative aerobic workload and ambulatory blood pressure (ABP) are lacking. The aim was to explore the relationship between objectively measured relative aerobic workload and ABP. A total of 116 cleaners aged 18-65 years were included after informed consent was obtained. A portable device (Spacelabs 90217) was mounted for 24-h measurements of ABP, and an Actiheart was mounted for 24-h heart rate measurements to calculate relative aerobic workload as percentage of relative heart rate reserve. A repeated-measure multi-adjusted mixed model was applied for analysis. A fully adjusted mixed model of measurements throughout the day showed significant positive relations (p < 0.001): a 1 % increase in mean relative aerobic workload was associated with an increase of 0.42 +/- A 0.05 mmHg (95 % CI 0.32-0.52 mmHg) in systolic ABP and 0.30 +/- A 0.04 mmHg (95 % CI 0.22-0.38 mmHg) in diastolic ABP. Correlations between relative aerobic workload and ABP were significant. Because workers may have an elevated relative aerobic workload for several hours each working day, this relationship may elucidate a mechanism behind the increased risk for cardiovascular disease among workers exposed to high levels of occupational physical activity

Does aerobic exercise improve or impair cardiorespiratory fitness and health among cleaners? A cluster randomized controlled trial.

ObjectiveIt is unknown if aerobic exercise overloads or improves the cardiovascular system among workers with high occupational physical activity. This was investigated in a worksite randomized controlled trial (RCT) of aerobic exercise among cleaners.MethodsWe randomized 116 cleaners between 18-65 years. The aerobic exercise group (N=57) performed worksite aerobic exercise (30 minutes twice a week) and the reference group (N=59) received lectures. Cardiorespiratory fitness, blood pressure (BP) and diurnal heart rate (HR) for measuring aerobic workload [% HR reserve (% HRR)] were collected at baseline and after four months. A repeated measure 2×2 multi-adjusted mixed-model design was applied to compare the between-group differences in an intention-to-treat analysis.ResultsBetween-group differences (P&lt;0.01) were found: cardiorespiratory fitness 2.2 [standard error (SE) 0.8] ml O 2 × min -1 × kg -1 [95% confidence interval (95% CI) 0.6-3.8], aerobic workload - 3.5 (SE 1.2) % HRR (95% CI - 5.9- -1.0), resting HR -3.8 (SE 1.2) bpm (95 % CI -6.1- - 1.4), sleeping HR -3.8 (SE 1.1) bpm (95% CI - 5.9- - 1.7), and systolic BP 3.6 (SE 1.3) mmHg (95% CI 1.1-6.0).ConclusionsWorksite aerobic exercise seems to improve cardiorespiratory fitness, aerobic workload, and resting and sleeping HR, but increase systolic BP among cleaners. Beneficial physiological cardiovascular effects are seen from aerobic exercise, but also a harmful effect is evident. Therefore, recommendations should take into consideration the potential cardiovascular overload from additional aerobic exercise on workers with high levels of occupational physical activity

Does aerobic exercise improve or impair cardiorespiratory fitness and health among cleaners?:A cluster randomized controlled trial

ObjectiveIt is unknown if aerobic exercise overloads or improves the cardiovascular system among workers with high occupational physical activity. This was investigated in a worksite randomized controlled trial (RCT) of aerobic exercise among cleaners.MethodsWe randomized 116 cleaners between 18-65 years. The aerobic exercise group (N=57) performed worksite aerobic exercise (30 minutes twice a week) and the reference group (N=59) received lectures. Cardiorespiratory fitness, blood pressure (BP) and diurnal heart rate (HR) for measuring aerobic workload [% HR reserve (% HRR)] were collected at baseline and after four months. A repeated measure 2×2 multi-adjusted mixed-model design was applied to compare the between-group differences in an intention-to-treat analysis.ResultsBetween-group differences (P&lt;0.01) were found: cardiorespiratory fitness 2.2 [standard error (SE) 0.8] ml O 2 × min -1 × kg -1 [95% confidence interval (95% CI) 0.6-3.8], aerobic workload - 3.5 (SE 1.2) % HRR (95% CI - 5.9- -1.0), resting HR -3.8 (SE 1.2) bpm (95 % CI -6.1- - 1.4), sleeping HR -3.8 (SE 1.1) bpm (95% CI - 5.9- - 1.7), and systolic BP 3.6 (SE 1.3) mmHg (95% CI 1.1-6.0).ConclusionsWorksite aerobic exercise seems to improve cardiorespiratory fitness, aerobic workload, and resting and sleeping HR, but increase systolic BP among cleaners. Beneficial physiological cardiovascular effects are seen from aerobic exercise, but also a harmful effect is evident. Therefore, recommendations should take into consideration the potential cardiovascular overload from additional aerobic exercise on workers with high levels of occupational physical activity