A Comparative Assessment of Ergonomic Risk Factors in University Personnel Using RULA and REBA Aiming to Study the Cause and Effect Relationship

The aim of this research was to conduct an ergonomic assessment of working postures and the design of computer workstations of the employees in Louisiana State University. The purpose of the study was threefold- (1) to determine the major ergonomic issues in university employees while working on computer workstations, (2) to compare the two ergonomic assessment tools (RULA and REBA) to see how similarly or differently they assess the risks present in the same working condition and (3) to develop a model that correlates between working condition, work posture and computer workstation design with their effects on musculoskeletal system. This research was constituted of a comprehensive survey (5 minutes) and a quantitative risk assessment session (20 minutes) conducted over 72 participants and their workstations in the university workplace. Along with the pre-assessment questionnaire; the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) and two ergonomic assessment tools REBA (Rapid Entire Body Assessment) and RULA (Rapid Upper Limb Assessment) were used to quantify the ergonomic risk factors. To evaluate the computer work stations “OSHA Computer Workstations eTool - Evaluation Checklist” was used. The most number of participants (75.71%) reported to suffer from upper and lower back pain. Next to it was shoulder and upper arm (45.71%) and then forearm and wrist (42.85%) discomfort. Average RULA score (5) was more than that of REBA (4) making RULA an assessment tool with better consistency while evaluating activities of upper limb, as working on computer workstation. In 85.48% of cases RULA score was the same or more than that of REBA which indicates the strenuous work of office employees cause a disorder more in the upper limbs than that of the lower limbs. Proportional odds ordinal regression model was used to identify the most significant factors contributing towards the WMSD symptoms which are, (1) inappropriate positioning of computer monitor and exposure to prolonged awkward posture of the (2) trunk or torso, (3) shoulder-upper arm, (4) forearm-elbows and (5) wrist and hand. Three equations were developed for predicting the probabilities of a user having slightly, moderately or very uncomfortable pain when the postural and design factors are given

The relationship between psychosis and offending behaviour in New South Wales - a data-linkage study

Background The relationship between serious mental conditions such as psychosis and criminal offending has gained increasing attention over time, particularly towards better management of prisoners with mental illness in the justice system. The extent to which psychosis contributes to offending is likely to vary across different practices of health and legal consideration. This thesis aims to examine the association between psychosis and offending in New South Wales (NSW), Australia. It also examines other aspects of this relationship, including the first diagnosis in prison and subsequent engagement in community treatments and post-release mortality of prisoners with and without a diagnosis of psychosis. Method A retrospective study involving a population-level data-linkage using health and justice data collections pertaining to the most populous state in Australia, and the jurisdiction with the largest number of offenders (including prisoners) was conducted. Multivariate logistic regression was used to examine the relationship between psychosis and offending, and factors associated with a first diagnosis of psychosis. Cox regression model was used to examine the association between the setting of the first diagnosis (prison/community) and subsequent engagement with community mental health care services, and to determine the risk of mortality among prisoners with psychosis. Results Individuals with a diagnosis of psychosis were five times as likely to offend than those without a diagnosis of psychosis; Individuals who were diagnosed for the first time with psychosis inside the prison were diagnosed sooner (79.1% within three months of incarceration); Individuals with a first diagnosis of psychosis inside prisons were three times as likely not to receive mental health care services post-release compared to those who were diagnosed for the first time in hospitals; Prisoners with prior diagnoses of psychosis were twice as likely to die post-release than prisoners without a diagnosis of psychosis. Discussion This study provides compelling evidence of an association between psychosis and offending suggesting alternative pathways for this group into treatment rather than incarceration. The research contained in this thesis has been acknowledged by the justice system in NSW who are currently developing better frameworks and mechanisms for this population under the banner of the NSW Premier’s Priorities

Mortality, criminal sanctions, and court diversion in people with psychosis

Importance: People living with psychosis experience excess premature mortality and are overrepresented in criminal legal systems, but little is known about mortality associated with criminal sanctions or diversion in this population. Objective: To examine associations of different types of recent (past 2 years) criminal sanction, including court diversion, with mortality among people with psychosis. Design, Setting, and Participants: This population-based, retrospective, data-linkage cohort study was conducted using 6 routinely collected administrative data collections from New South Wales, Australia, relating to health, court proceedings, imprisonment, and mortality. Participants (adults aged ≥18 years hospitalized for psychotic disorders) entered observation at the time of discharge from their first psychosis-related hospital admission (or their 18th birthday if aged &lt;18 years) between July 2001 and November 2017 and were followed-up until May 2019. Data were analyzed between February 2023 and April 2024. Exposures: Recent (past 2 years) criminal sanction type, a time-varying variable with 5 categories: no recent criminal sanction, recent mental health court diversion, recent community sanction, current imprisonment, and recent prior imprisonment (ie, recent prison release). Main Outcomes and Measures: Causes of death were described, and age- and sex-specific mortality rates by recent criminal sanction type were calculated. In those younger than 65 years, Cox regression was used to examine associations of all-cause and external-cause mortality with recent criminal sanction type, adjusting for sociodemographic, health-related, and offense-related confounders. Results: The cohort included 83 071 persons (35 791 female [43.1%]; 21 208 aged 25-34 years [25.5%]; median [IQR] follow-up, 9.5 [4.8-14.2] years), of whom 25 824 (31.1%) received a criminal sanction. There were 11 355 deaths. In those aged younger than 65 years, recent mental health court diversion, community sanctions, and prior imprisonment were associated with increased hazards of all-cause and external-cause mortality compared with no recent sanction, with the largest adjusted hazard ratios (aHRs) observed for recent prior imprisonment (all-cause mortality: aHR, 1.69; 95% CI, 1.50-1.91; external-cause mortality: aHR, 2.64; 95% CI, 2.27-3.06). Conclusions and Relevance: In this cohort study of people with psychosis, recent criminal sanctions were associated with increased mortality irrespective of sanction type. These findings suggest that future research should develop strategies to improve health and safety in people with psychosis who have criminal legal system contact.</p

Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial

Background Post-partum haemorrhage is the leading cause of maternal death worldwide. Early administration of tranexamic acid reduces deaths due to bleeding in trauma patients. We aimed to assess the effects of early administration of tranexamic acid on death, hysterectomy, and other relevant outcomes in women with post-partum haemorrhage. Methods In this randomised, double-blind, placebo-controlled trial, we recruited women aged 16 years and older with a clinical diagnosis of post-partum haemorrhage after a vaginal birth or caesarean section from 193 hospitals in 21 countries. We randomly assigned women to receive either 1 g intravenous tranexamic acid or matching placebo in addition to usual care. If bleeding continued after 30 min, or stopped and restarted within 24 h of the first dose, a second dose of 1 g of tranexamic acid or placebo could be given. Patients were assigned by selection of a numbered treatment pack from a box containing eight numbered packs that were identical apart from the pack number. Participants, care givers, and those assessing outcomes were masked to allocation. We originally planned to enrol 15 000 women with a composite primary endpoint of death from all-causes or hysterectomy within 42 days of giving birth. However, during the trial it became apparent that the decision to conduct a hysterectomy was often made at the same time as randomisation. Although tranexamic acid could influence the risk of death in these cases, it could not affect the risk of hysterectomy. We therefore increased the sample size from 15 000 to 20 000 women in order to estimate the effect of tranexamic acid on the risk of death from post-partum haemorrhage. All analyses were done on an intention-to-treat basis. This trial is registered with ISRCTN76912190 (Dec 8, 2008); ClinicalTrials.gov, number NCT00872469; and PACTR201007000192283. Findings Between March, 2010, and April, 2016, 20 060 women were enrolled and randomly assigned to receive tranexamic acid (n=10 051) or placebo (n=10 009), of whom 10 036 and 9985, respectively, were included in the analysis. Death due to bleeding was significantly reduced in women given tranexamic acid (155 [1·5%] of 10 036 patients vs 191 [1·9%] of 9985 in the placebo group, risk ratio [RR] 0·81, 95% CI 0·65–1·00; p=0·045), especially in women given treatment within 3 h of giving birth (89 [1·2%] in the tranexamic acid group vs 127 [1·7%] in the placebo group, RR 0·69, 95% CI 0·52–0·91; p=0·008). All other causes of death did not differ significantly by group. Hysterectomy was not reduced with tranexamic acid (358 [3·6%] patients in the tranexamic acid group vs 351 [3·5%] in the placebo group, RR 1·02, 95% CI 0·88–1·07; p=0·84). The composite primary endpoint of death from all causes or hysterectomy was not reduced with tranexamic acid (534 [5·3%] deaths or hysterectomies in the tranexamic acid group vs 546 [5·5%] in the placebo group, RR 0·97, 95% CI 0·87-1·09; p=0·65). Adverse events (including thromboembolic events) did not differ significantly in the tranexamic acid versus placebo group. Interpretation Tranexamic acid reduces death due to bleeding in women with post-partum haemorrhage with no adverse effects. When used as a treatment for postpartum haemorrhage, tranexamic acid should be given as soon as possible after bleeding onset. Funding London School of Hygiene & Tropical Medicine, Pfizer, UK Department of Health, Wellcome Trust, and Bill & Melinda Gates Foundation

Masivukeni: Development of a Multimedia Based Antiretroviral Therapy Adherence Intervention for Counselors and Patients in South Africa

Effective medical treatment for HIV/AIDS requires patients’ optimal adherence to antiretroviral therapy (ART). In resource-constrained settings, lack of adequate standardized counseling for patients on ART remains a significant barrier to adherence. Masivukeni (“Let’s Wake Up” in Xhosa) is an innovative multimedia-based intervention designed to help people living with HIV in resource-limited settings achieve and maintain high levels of ART adherence. Adapted from a couples-based intervention tested in the United States (US), Masivukeni was developed through community-based participatory research with US and South African partners and informed by Ewart’s Social Action Theory. Innovative computer-based multimedia strategies were used to translate a labor- and training-intensive intervention into one that could be readily and widely used by lay counselors with relatively little training with low-literacy patients. In this paper, we describe the foundations of this new intervention, the process of its development, and the evidence of its high acceptability and feasibility

Competence of healthcare professionals in diagnosing and managing obstetric complications and conducting neonatal care: a clinical vignette-based assessment in district and subdistrict hospitals in northern Bangladesh

Background This study assesses the competency of maternal and neonatal health (MNH) professionals at district-level and subdistrict-level health facilities in northern Bangladesh in managing maternal and newborn complications using clinical vignettes. The study also examines whether the professional’s characteristics and provision of MNH services in health facilities influence their competencies. Methods 134 MNH professionals in 15 government hospitals were interviewed during August and September 2016 using structured questionnaire with clinical vignettes on obstetric complications (antepartum haemorrhage and pre-eclampsia) and neonatal care (low birthweight and immediate newborn care). Summative scores were calculated for each vignette and median scores were compared across different individual-level and health facility-level attributes to examine their association with competency score. Kruskal-Wallis test was performed to identify the significance of association considering a p value<0.05 as statistically significant. Results The competency of MNH professionals was low. About 10% and 24% of the health professionals received ‘high’ scores (>75% of total) in maternal and neonatal vignettes, respectively. Medical doctors had higher competency than nurses and midwives (score=11 vs 8 out of 19, respectively; p=0.0002) for maternal vignettes, but similar competency for neonatal vignettes (score=30.3 vs 30.9 out of 50, respectively). Professionals working in health facilities with higher use of normal deliveries had better competency than their counterparts. Professionals had higher competency in newborn vignettes (significant) and maternal vignettes (statistically not significant) if they worked in health facilities that provided more specialised newborn care services and emergency obstetric care, respectively, in the last 6 months. Conclusions Despite the overall low competency of MNH professionals, exposure to a higher number of obstetric cases at the workplace was associated with their competency. Arrangement of periodic skill-based and drill-based in-service training for MNH professionals in high-use neighbouring health facilities could be a feasible intervention to improve their knowledge and skill in obstetric and neonatal care

Competence of healthcare professionals in diagnosing and managing obstetric complications and conducting neonatal care: a clinical vignette-based assessment in district and subdistrict hospitals in northern Bangladesh

Background This study assesses the competency of maternal and neonatal health (MNH) professionals at district-level and subdistrict-level health facilities in northern Bangladesh in managing maternal and newborn complications using clinical vignettes. The study also examines whether the professional’s characteristics and provision of MNH services in health facilities influence their competencies. Methods 134 MNH professionals in 15 government hospitals were interviewed during August and September 2016 using structured questionnaire with clinical vignettes on obstetric complications (antepartum haemorrhage and pre-eclampsia) and neonatal care (low birthweight and immediate newborn care). Summative scores were calculated for each vignette and median scores were compared across different individual-level and health facility-level attributes to examine their association with competency score. Kruskal-Wallis test was performed to identify the significance of association considering a p value<0.05 as statistically significant. Results The competency of MNH professionals was low. About 10% and 24% of the health professionals received ‘high’ scores (>75% of total) in maternal and neonatal vignettes, respectively. Medical doctors had higher competency than nurses and midwives (score=11 vs 8 out of 19, respectively; p=0.0002) for maternal vignettes, but similar competency for neonatal vignettes (score=30.3 vs 30.9 out of 50, respectively). Professionals working in health facilities with higher use of normal deliveries had better competency than their counterparts. Professionals had higher competency in newborn vignettes (significant) and maternal vignettes (statistically not significant) if they worked in health facilities that provided more specialised newborn care services and emergency obstetric care, respectively, in the last 6 months. Conclusions Despite the overall low competency of MNH professionals, exposure to a higher number of obstetric cases at the workplace was associated with their competency. Arrangement of periodic skill-based and drill-based in-service training for MNH professionals in high-use neighbouring health facilities could be a feasible intervention to improve their knowledge and skill in obstetric and neonatal care

Quality of care during childbirth at public health facilities in Bangladesh: a cross-sectional study using WHO/UNICEF ‘Every Mother Every Newborn (EMEN)’ standards

Background This manuscript presents findings from a baseline assessment of health facilities in Bangladesh prior to the implementation of the ‘Every Mother Every Newborn Quality Improvement’ initiative. Methodology A cross-sectional survey was conducted between June and August 2016 in 15 government health facilities. Structural readiness was assessed by observing the physical environment, the availability of essential drugs and equipment, and the functionality of the referral system. Structured interviews were conducted with care providers and facility managers on human resource availability and training in the maternal and newborn care. Observation of births, reviews of patient records and exit interviews with women who were discharged from the selected health facilities were used to assess the provision and experience of care. Results Only six (40%) facilities assessed had designated maternity wards and 11 had newborn care corners. There were stock-outs of emergency drugs including magnesium sulfate and oxytocin in nearly all facilities. Two-thirds of the positions for medical officers was vacant in district hospitals and half of the positions for nurses was vacant in subdistrict facilities. Only 60 (45%) healthcare providers interviewed received training on newborn complication management. No health facility used partograph for labour monitoring. Blood pressure was not measured in half (48%) and urine protein in 99% of pregnant women. Only 27% of babies were placed skin to skin with their mothers. Most mothers (97%) said that they were satisfied with the care received, however, only 46% intended on returning to the same facility for future deliveries. Conclusions Systematic implementation of quality standards to mitigate these gaps in service readiness, provision and experience of care is the next step to accelerate the country’s progress in reducing the maternal and neonatal deaths

Evaluating the effectiveness of COVID-19 vaccines in adults with sickle cell disease during the Omicron period of COVID-19 pandemic

Background and aimsThe Omicron variant, one of the variants causing the coronavirus disease of 2019 (COVID-19), was first identified in November 2021 and became the predominant variant in 2022. Although causing less severe disease, this variant and its subvariants have been associated with increased transmissibility and limited protection despite vaccination and prior infection. Individuals with sickle cell disease (SCD) are particularly at greater risk of severe illness and death, and studies regarding the effectiveness of COVID-19 vaccination have been limited in this population. The study aims to determine the effectiveness of COVID-19 vaccination during this period among individuals with SCD and to examine various factors that can influence the likelihood of COVID-19 infection and severity among SCD individuals.MethodsThis is a retrospective analysis of adult patients (≥18 years) with SCD who had emergency and inpatient encounters between January 1 and December 31, 2022. Multivariable regression analysis was performed to determine the effectiveness of the COVID-19 vaccine among this population.ResultsThe study found that COVID-19 vaccination lowered the infection risk among SCD individuals by over 70% if they have received at least one dose of the vaccine. The study also found that individuals with SCD and a history of acute chest syndrome were over 3 times more likely to have a COVID-19 infection diagnosis than those without a history of acute chest syndrome.ConclusionThe study confirms the effectiveness of the COVID-19 vaccine among individuals with SCD during the Omicron period of the COVID-19 pandemic