As the intensity of nursing work increases, so does the need for possibilities to relax during working hours. Surveying the utilization of breaks among 201 female Finnish nurses in ten wards (internal medicine, geriatrics) by questionnaire, 19% reported that they were unable to take the breaks officially agreed upon. For the registered nurses this proportion was as high as 36%. This indicates that special solutions must be sought to allow the nursing staff to utilize their right to short relaxation periods during working hours.

In nursing, the strain resulting from physical, mental and social work loads depends on both individual work capacity and the performance of the group. The relation between assessments of individual work capacity and assessments of the performance of the ward as a whole was determined on 10 wards, on the basis of questionnaire answers concerning personal physical and mental performance, as well as effectiveness, flexibility, division of tasks and cooperation of all the nursing staff. No relation between average individual performance and group performance was found. Group performance ratings were closely associated with management atmosphere and supervisor support. The opinions of the auxiliary nurses were mostly decisive for the general opinion of the staff.

A method for evaluation of the physical load on the lumbar spine in industrial work is presented. It is suitable for identification of high spinal loads and their time duration. The method is based on biomechanical analysis of video-recordings. It takes into account the posture of the body as such, as well as the possible occurrence of external load and support. Compression of the L5-S1 intervertebral disc and strain on the lumbodorsal fascia is determined at 5-s intervals in each work task.

Abstract Objective: To assess the effect on the rate of ventilator-associated pneumonia (VAP) of decreasing the frequency of ventilator circuit changes from three times to once per week. Design: Prospective, randomized trial. Setting: Medical intensive care unit (MICU), a 12-bed, critical-care internal medicine unit, and neurosciences intensive care unit (NICU), a 21-bed, predominantly adult neurosurgical unit, of an urban university hospital. Patients: All 447 patients requiring mechanical ventilation during October 1992 through June 1993. Intervention: Patients were allocated randomly on the basis of permanent medical record numbers: those with odd numbers had circuits changed three times per week, those with even numbers once per week. Intensive-care-unit surveillance was conducted in accordance with definitions and methods of the National Nosocomial Infections Surveillance System. Results: In the MICU, the one-change-per-week group had a VAP rate of 7.3 per 1,000 ventilator days, versus 5.9 for the three-per-week group (P=.6). In the NICU, the one-change-per-week group had a rate of 12.2 per 1,000 ventilator days, versus 12.6 for the three-per-week group (P=.9). Considering patients in both units ventilated for no more than 7 days, the one-change-per-week group had a VAP rate of 5.9 per 1,000 ventilator days, versus 9.0 per 1,000 for the three-changes-per-week group (odds ratio [OR], 0.65; 95% confidence interval [CI95], 0.25 to 1.69). Including patients in the two units maintained on mechanical ventilation for more than 7 days, the one-change-perweek group had a VAP rate of 13.2 per 1,000 ventilator days, versus 9.6 per 1,000 for the three-changes-per-week group (OR, 1.37; CI95 0.71 to 2.65). Conclusions: Decreasing the frequency of ventilator circuit changes from three times to once per week had no adverse effect on the overall rate of VAP. Less frequent ventilator circuit changes may decrease the incidence of VAP among patients ventilated for no more than 1 week. However, the incidence of VAP may be higher among patients with once weekly circuit changes ventilated for more than 1 week.

158 males employees in the metal industry, aged 35-44 years, were examined to determine the prevalence of tenderness and pain in the neck and shoulders. Type A behaviour was assessed by a series of 16 questions. One or more tender sites were found in 30% and more than three in 7% of the examined employees. Tenderness was twice as common among those with interview-based pain in the past 12 months (40%) as among those without pain (23%). Those with tenderness on palpation more often had a type A behaviour than those without tenderness (p = 0.010). The association was modified by pain but not by occupation. One explanation for the association between tenderness and behaviour might be that type A personality is associated with increased muscle activity in the neck and shoulders leading to muscular fatigue and tenderness.

The reproducibility of nine back function tests suitable for use in the occupational health service was determined in 30 male employees. The correlation of three tests made with a tape measure--forward bending, modified Schober, and side bending--was high in both intra- and inter-observer comparisons (r = 0.82-0.96). Immediate repetition of the testing procedure improved the performance in the forward and side bending tests. The reproducibility was also good for the tests of dynamic (K = 0.57-0.78) and endurance (r = 0.90-0.96) strength of the abdominal muscles and quite good for the test of endurance strength of the back muscles (r = 0.74-0.80). The differences between the examiners must be taken into account in the modified Schober test, and in testing the flexibility of the hip flexors and hamstrings and the endurance strength of the back muscles.

In this study of lumbar degeneration and the role of mechanical loading in its development, lateral lumbar radiographs of 216 concrete reinforcement workers and 201 house painters aged 25-54 years were examined. Disc space narrowing occurred at about 10 years and spondylophytes at about 5 years younger age in the former than in the latter group. Risk ratios (RR) were estimated from the regression coefficients of logistic regression models. RR for the univariate effect of occupation on disc space narrowing was 1.8, and adjustment for age, earlier back accidents, height, body mass index and smoking had only a minor effect on this relationship, adjusted RR 1.8. The crude RR for spondylophytes was 1.5, and the adjusted RR 1.6. Earlier back accidents showed a significant univariate relationship with DSN, but in multivariate analysis this variate did not retain its significance. It was concluded that heavy physical work enhances the degenerative process of the lumbar spine. Materials handling and postural loading are proposed to be occupational factors of importance in the development of both disc space narrowing and spondylophytes.

A new base, long-range transportation plan being developed in Virginia is discussed, and recommendations are made on highway, transit and other improvements needed to maintain traffic service levels. Transit options under consideration include extensive bus service improvements, some on exclusive lanes, Metrorail extensions and commuter rail. Citizen support was strong for an HOV (high occupancy vehicles) system to form a grid of interconnected routes serving existing high traffic centers. Major new highways were recommended. The planning will be incorporated into an overall update of the regional transportation plan which includes Maryland jurisdictions and the District of Columbia.

The association between radiographically detectable degenerative changes in the lumbar spine and back symptoms was studied, along with the possible effect of occupational work load. The subjects were 216 concrete reinforcement workers and 201 house painters. A questionnaire provided information on work history and earlier back accidents, and a standardized interview produced data on back symptoms. The occurrence of disc space narrowing, anterior and posterior spondylophytes, and end-plate sclerosis was recorded separately for each intervertebral space from lateral lumbar radiographs. Moderate to severe degenerative changes were associated with increased risk of sciatic pain but not with the occurrence of lumbago or nonspecific back pain. The different types of degenerative changes provided no further information. In a multivariate logistic regression analysis degenerative changes and earlier back accidents were significant independent predictors of sciatic pain. When these two variates were allowed for, the effect of occupation was not significant.

In a study of the association of occupation and several other determinants with the occurrence of sciatic pain, 167 concrete reinforcement workers and 161 house painters were followed for five years. Base-line data were obtained with a questionnaire, an interview on back symptoms, a clinical examination, and a radiograph of the lumbar spine. Follow-up data on back symptoms were obtained with a postal questionnaire. Concrete reinforcement work was associated with an increase in the risk of sciatic pain, in both a cross-sectional and a prospective study. Reported back accidents contributed to the risk of sciatic pain. Previous history of back symptoms was the most powerful predictor of sciatic pain prospectively. Degenerative changes were related to sciatic pain in retrospect, but prospectively this relationship was weaker. Body height and history of stress episodes showed some association with sciatic pain; abdominal muscle strength, body mass index, and smoking did not; and back muscle strength was associated only retrospectively.

The international classification of diseases is unsuitable for epidemiologic research on the etiology of degenerative back disease. In cross-sectional studies of occupationally active populations, the occurrence of various symptoms and signs of back disease may be established. However, recommendations as to what data to gather or how to combine it into meaningful entireties are not yet established. To validate reported sciatic pain by clinical findings, 252 reinforcement workers and 231 painters, all men, 20-64 years of age, were examined by nine tests. In the reinforcement workers exposed to heavy occupational loads the reports of sciatica during the previous month were clearly related to several clinical findings. The tests for restriction and pain on bending forward and sideward gave sensitivity values of 0.36-0.61 and specificity values of 0.82-0.87. Combining the results of the separate tests into pairs enhanced the sensitivity to 0.62-0.68, but reduced the specificity to 0.77-0.78. Referring to the current results, recommendations include a structured inquiry into sciatic pain during the previous month, backed up by clinical tests for range of and pain on lumbar movement, when studying the occurrence of back syndromes in physically heavy trades.

The Metropolitan Washington Council of Governments (COG) is conducting a major survey to catalogue the daily travel habits of thousands of area residents. Referred to as Home Interview Survey because the basic survey unit is the household, the project will acquire detailed information from more than 6,000 randomly-selected households. The survey consists of two parts. Randomly-selected households are contacted by phone to solicit their participation and to collect basic information about the household's characteristics. Those households agreeing to participate are sent a set of travel diaries on which each household member (above the age of five) is asked to record every trip he or she makes on an assigned day. Three kinds of information are being collected in the survey: 1) specific trip information; 2) specific household information; and 3) specific factual information about each household member. One of the survey questions is unique in that it deals, not only with facts, but also with peoples' attitudes about their travel experience. Participants are asked to rate the time needed to complete each trip on their travel log on a four-point scale from good to poor. This measure of user satisfaction will be related to other survey data to see, for example, if transit users tend to be more or less satisfied than auto drivers with trips of similar lengths, or if travelers perceive travel times differently depending on such factors as trip purpose or trip location. This information can greatly aid decision makers in devising and evaluating useful and acceptable transportation policy options.