Rebuilding and strengthening health systems and providing basic health services in fragile states

The international community has compelling humanitarian, political, security and economic reasons to engage in rebuilding and strengthening health systems in fragile states. Improvements in health services and systems help to strengthen civil society and to restore legitimacy to governments. Effective engagement with fragile states to inform the design of health programmes and selection of interventions depends on donor coordination and an understanding of health system challenges. Planning requires consideration of allocation (services to be delivered), production (organisation of services), distribution (beneficiaries of services) and financing. The criteria for selecting interventions are: their impact on major health problems; effectiveness; the possibility of scale-up; equity; and sustainability. There are various options for financing and models of engagement, but support should always combine short-term relief with longer-term development. Stakeholders should aim not only to save lives and protect health but also to bolster nations' ability to deliver good-quality services in the long run.     

The moderating effects of job control and selection,optimization, and compensation strategies on the age–work ability relationship

Work ability describes employees' capability to carry out their work with respect to physical and psychological job demands. This study investigated direct and interactive effects of age, job control, and the use of successful aging strategies called selection, optimization, and compensation (SOC) in predicting work ability. We assessed SOC strategies and job control by using employee self‐reports, and we measured employees' work ability using supervisor ratings. Data collected from 173 health‐care employees showed that job control was positively associated with work ability. Additionally, we found a three‐way interaction effect of age, job control, and use of SOC strategies on work ability. Specifically, the negative relationship between age and work ability was weakest for employees with high job control and high use of SOC strategies. These results suggest that the use of successful aging strategies and enhanced control at work are conducive to maintaining the work ability of aging employees. We discuss theoretical and practical implications regarding the beneficial role of the use of SOC strategies utilized by older employees and enhanced contextual resources at work for aging employees. Copyright © 2012 John Wiley & Sons, Ltd.     

地铁施工灾害关键警兆监测指标研究

为实现地铁施工灾害警兆的实时监测和重点跟踪,预防和减少地铁施工灾害的发生,应用WBS-RBS及关联规则对地铁施工灾害关键警兆监测指标进行科学选取。通过分析以往地铁施工事故,针对基坑工程采用WBS-RBS方法,全面识别施工过程中的风险源,并运用基坑工程警兆监测指标关联规则模型对"地墙渗漏"警兆的20组样本数据进行计算分析,得到警兆与监测指标的频繁项集,从而甄选出关键警兆监测指标。结果表明,由于关联规则的存在,当警兆监测指标组合中某个指标超过阈值时,组合中可能存在其他指标同时超过其指标阈值,因此这时应加强对其他指标的监测。     

Repetitive Strain in Nonrepetitive Work: A Case Study

In a Québec factory, a woman in a nontraditional job suffered from epicondylitis whereas her male coworkers were unaffected. A study was undertaken in order to enumerate the operations at risk for epicondylitis. Workers were interviewed in order to identify difficult operations and systematic observations were done over 4 work days. Although tasks were extremely varied, certain movements at risk for epicondylitis were repeated many times. Fifty-three valves were turned against resistance as part of this job, and one valve requiring a particularly difficult movement was turned 20 times in one day. There were at least 61 operations at risk for epicondylitis per day over a 4-day period. Strain on the elbow joint was particularly intense for the woman worker because the design of the workplace gave an advantage to taller workers with larger hands. Although this case study does not permit us to conclude that the worker’s epicondylitis was due to her job, it enables us to suggest that it would be wise to adapt the dimensions of relevant equipment and worksites to a wider range of potential worker sizes. We also raise some questions about the definition of repetitive strain in epidemiological studies. We suggest that it may be necessary to consider not only the cycle time but also the total of forces exerted on a joint in order to study workplace injuries to the musculoskeletal system.     

Musculoskeletal Load Assessment of the Upper Limb Positions Subjectively Chosen as the Most Convenient

Work posture is determined by interdependence between work stand design, the necessity to perform given activities, and the anthropometric dimensions of the worker, but it also depends on individual preferences. The aim of the study was to compare the musculoskeletal load of the right upper extremity under conditions of imposed (standard) upper limb position and subjectively chosen ones, and to assess the influence of the changes in magnitude of the external force on the musculoskeletal load in the examined limb positions. Ten healthy male participants took part in the study. Muscular load associated with different upper extremity positions with and without external load were assessed. Musculoskeletal load for standard and subjectively chosen limb positions and two different values of external load were compared by means of theoretical and experimental methods. Results indicate that differences in musculoskeletal load between imposed and subjectively chosen limb positions were not high enough to show statistically significant differences, and the upper limb position chosen by the participant does not always cause the lowest musculoskeletal load.     

Box Handling in the Loading and Unloading of Vans

The handling of 2,306 boxes being loaded or unloaded from vans onto or from 4-wheeled trolleys by 31 handlers in a warehouse were characterized. Handling was videotaped and characterized through an analysis grid completed by three trained observers. The following execution parameters were observed: nature of the exertion applied by the upper limbs, plane and direction of the exertion, resulting displacement of the box, grip, use of the lower limbs and the back. Results show that execution parameters used by handlers vary considerably from those usually recommended or studied. For example, symmetric grips were rarely used (4%). The grip was modified during the handling of half the boxes. Significant knee flexion was rarely observed (3% of exertions). Each box was moved by applying an average of . 3.5 different exertions. Exertions were mostly applied in a plane parallel to the shoulders; they were rarely executed in a strict sagittal plane (11%). The implication of these observations are discussed.     

A Model to Analyze Ergonomics Working Conditions

An ergonomics and safety model to assess and evaluate the most critical industrial improvement areas in a developing nation. This study was initiated and supported by a Fortune 500 Corporation interested in improving its global operations in developing nations. This initiative was also fully supported by an emerging nation that was concerned with its ergonomics and safety problems. The model was tested and validated in the emerging nation and the results were used to further enhance the model so that it can be implemented and adapted to other similar work environments. The model provides a practical methodology that analyzes and evaluates an emerging nation’s current work environments, suggests practical solutions, and recommends effective remedies.     

Circadian Rhythm of Heart Rate,Urinary Cortisol Excretion,and Sleep in Civil Air Traffic Controllers

The examination of Air Traffic Controllers (ATCs) from the Warsaw Airport (Poland) included 24-hr ECG monitoring. The participants were 10 civil ATCs, 9 males and 1 woman. The study was carried out on a group of 19 ATCs during their duty periods, 14 of them working 12-hr shifts and 5 performing 24-hr duties. The participants collected urine every 4 hrs, and Cortisol concentration was determined. Further, the survey included the quality and duration of sleep, and subjective fatigue in the 62 participants.

In ATCs, shift work modifies natural rhythms of the circulatory system and decreases the ability for intensified mental work at night. In consequence ATCs experience frequent sleep disorders.     

Combined Effects of Physical Demands and Shift Working on Low Back Disorders Among Nursing Personnel

The aim of this study was to investigate the synergistic effects of physical demands and shift working on low back disorders (LBDs) among nursing personnel. The study used 2 questionnaires: a self-administered questionnaire composed of parts of Nordic musculoskeletal questionnaire to assess LBDs and job content questionnaire to assess physical demands. The participants were divided into 4 groups: from group 1 (low physical demands day workers) to group 4 (high physical demands shift workers). In regression analysis, high physical demands were associated with the prevalence of LBDs independently (OR 4.4, 95% CI [2.40, 8.00] and p < .05), but there was no association between shift working and LBDs (p > .05). Odds ratio in high physical demands shift workers was 9.33 compared to the reference group (p < .001). Calculated synergistic index was 7.37. Simultaneous impacts of shift working and high physical demands may increase the prevalence of LBDs among nursing personnel.     

Occupational Risk Identification Using Hand-Held or Laptop Computers

This paper describes the Work Environment Profile (WEP) program and its use in risk identification by computer. It is installed into a hand-held computer or a laptop to be used in risk identification during work site visits. A 5-category system is used to describe the identified risks in 7 groups, i.e., accidents, biological and physical hazards, ergonomic and psychosocial load, chemicals, and information technology hazards. Each group contains several qualifying factors. These 5 categories are colour-coded at this stage to aid with visualization. Risk identification produces visual summary images the interpretation of which is facilitated by colours. The WEP program is a tool for risk assessment which is easy to learn and to use both by experts and nonprofessionals. It is especially well adapted to be used both in small and in larger enterprises. Considerable time is saved as no paper notes are needed.