published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

One in three American older adults fall every year, making falls the leading cause of nonfatal injury treated in the emergency department (Centers for Disease Control and Prevention [CDC], 2013). Fall-related injuries cost the United States healthcare system nearly $30 billion a year and result in 27,000 deaths per year (Burns, Stevens, & Lee, 2016). The risk of falls increases with age, occurring more often in women than man. Age-related muscle weakness and functional decline contribute to fall risk. Age-related changes in neuroendocrine hormone production and shifts in circadian rhythms promote sleep disorders, affecting nearly two-thirds of older adults. Poor sleep quality over time leads to drowsiness and impaired attention span and judgment. The purpose of this secondary analysis of a previously collected data set was to describe the relationships among frailty, subjective sleep quality, and falls in community-dwelling older adults. This secondary analysis also sought to determine the extent to which frailty and subjective sleep quality predict risk of future falls among community-dwelling older adults. Correlational analyses were performed to determine the nature and significance of the relationship between sleep quality and falls, frailty and falls, and sleep quality and frailty. A multiple regression analysis was performed to determine if sleep quality and frailty combined could predict falls. Frailty was found to account for a small variance in fall risk. However, sleep quality was not significantly related to falls nor was sleep quality predictive of falls. Risk for falls should be assessed at every clinical encounter and efforts to promote restful sleep should be addressed at least annually to reduce the risks of falls, functional decline, and sleep disorders among older adults in the community. / Includes bibliography. / Dissertation (Ph.D.)--Florida Atlantic University, 2017. / FAU Electronic Theses and Dissertations Collection

The purpose of this project was to review anterior cruciate ligament (ACL) literature and develop a performance evaluation and injury risk assessment (PIER) for female soccer players. A strategy guide for decreasing injury risk and enhancing performance was developed in hopes to bring awareness to the athletic community about ACL injury for female soccer players.

Graduation date: 2004

Thesis (MScPhysio)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Aims: To assess the effect of a vertical height adjustment of the chair and visual display unit (VDU) on work related upper quadrant musculoskeletal pain (WRUQMP) and sitting comfort in computer users. The upper quadrant refers to the occiput, cervical and upper thoracic spine including the clavicles and scapulae. Methods: An N=1 study was conducted using the ABC design whereby an ergonomic workstation adjustment, of VDU and chair height, was compared to the subject’s usual workstation settings. Pain and sitting comfort were measured using visual analogue scales (VAS). The subject was assessed over the four week phases as she performed her typical VDU work. The results were compiled and tabulated. Results: Both the mean and variance in pain intensity decreased after the workstation intervention. A deterioration was noted in sitting comfort. Conclusion: The vertical height adjustment of the chair and VDU may have contributed to a decrease in WRUQMP in this subject. This safe, economical workstation intervention may be a practical management option for the computer user suffering from WRUQMP. Further research into the measurement of comfort whilst sitting at a computer workstation, is recommended. / AFRIKAANSE OPSOMMING: Doelwitte: Om die effek te bepaal van n vertikale aanpassing van die stoel en beeldskerm van rekenaargebruikers op werksverwandte boonste kwadrant muskuloskeletale pyn en sitgemak. Die boonste kwadrant verwys na die oksiput, servikale en boonste torakale werwelkolom en sluit ook die klavikel en skapula in. Methode: Die N=1 studie is onderneem met gebruik van die ABC ontwerp in terme waarvan n ergonomiese aanpassing van stoel en beeldskerm vergelyk is met die normale gebruik van die deelnemer. Pyn en sitgemak is gemeet deur die gebruik van die Visueel analoogskaal. Die interwensies is ge-evalueer oor vierweekfases tydens normale rekenaar gebruik van die deelnemer. Die resultate is saamgestel en getabuleer. Uitkoms: Beide die gemiddelde en veranderlike pynintensiteit het verminder nadat die werkstasie aangepas is. Geen verbetering in sitgemak is opgemerk nie. Gevolgtrekking: Die vertikale hoogte-aanpassing van die stoel en beeldskerm het moontlik bygedra tot die verminderde pynvlakke in hierdie deelnemer. Hierdie veilige, ekonomiese verstelling is moontlik n praktiese beheeropsie vir rekenaargebruikers wat werksverwandte boonste kwadrant muskuloskeletale pyn verduur. Verder studie in die meet en waarneming van sitgemak tydens rekenaarwerk is nodig.

Thesis (MScPhysio)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Aims: To assess the effect of a chair and computer screen height adjustment on the neck and upper back musculoskeletal symptoms in an office worker. Methods: An N=1 study was conducted using the ABC design. Ethics approval was obtained for the study and the participant provided informed written consent. The participant was assessed over three four week phases as she performed her habitual computer work. The outcome measures assessed during the three phases were the pain intensity and perceived sitting comfort. The three phases were named the baseline, intervention and wash-out phases. During the baseline phase, the outcome measures were obtained at the participant‟s habitual work station. The intervention phase involved a vertical adjustment of the chair and computer screen height. The wash-out phase allowed the participant to adjust the chair and computer screen height to their choice. A follow-up interview was conducted with the participant three months after completion of the study. The mean values and the ranges of the pain intensity and perceived comfort were obtained and compared. The data collected was captured on a Microsoft Excel 2010 spread sheet, where after the data was tabulated and presented graphically. Results: The mean pain intensity of the participant increased slightly during the intervention phase in comparison to the baseline phase, but remained stable during the wash-out phase. The mean perceived sitting comfort deteriorated initially during the intervention phase, but improved later during the intervention phase and showed greater improvement during the wash out phase. The perceived sitting comfort showed more improvement than the pain intensity during the washout phase. Both the pain intensity and perceived sitting comfort showed improvement at the three months follow up assessment, post completion of the study. Conclusion: The vertical height adjustment of the chair and the VDT did not improve the participant‟s pain intensity and perceived sitting comfort when compared to the participant‟s habitual workstation parameters. The findings do not favour the horizontal viewing angle. The findings of this study however support the use of „slightly below horizontal‟ viewing angle as being conducive to reduce the pain intensity and improve the sitting comfort of an office worker. / AFRIKAANSE OPSOMMING: Doelstelling: Om die effek te bepaal van die hoogte aanpassing van die stoel en rekenaarskerm op die nek en bo-rug muskuloskeletale simptome van 'n kantoorwerker. Metodes: „n N=1 studie was uitgevoer deur gebruik te maak van die ABC ontwerp. Etiese goedkeuring was verkry vir die studie en die deelnemer het ingeligte skriftelike toestemming verleen. Die deelnemer was ge-evalueer oor drie vier week-lange fases terwyl sy haar gewone rekenaarwerk verrig het. Die uitkomsmetings ge-evalueer tydens die drie fases was pyn intensiteit en waargenome sitgemak. Die drie fases was genoem die basislyn, intervensie en uitwas fases. Gedurende die basislyn fase was die uitkomsmetings by die deelnemer se gewone werkstasie ingevorder. Die intervensie fase het 'n vertikale aanpassing van die stoel en rekenaarskerm behels. Die uitwas fase het die deelnemer toegelaat om haar stoel en rekenaarskerm se hoogte aan te pas volgens haar keuse. 'n Opvolg onderhoud was gevoer met die deelnemer drie maande na die voltooiing van die studie. Die resultate was vasgelê op 'n Microsoft Excel 2010 data bladsy, waarna die data getabuleer en grafies uitgebeeld is. Resultate: Die gemiddelde pyn intensiteit van die deelnermer het effens toegeneem tydens die intervensie fase in vergelyking met die basislyn fase, maar het stabiel gebly tydens die uitwas fase. Die gemiddelde waargenome sitgemak het aanvanklik verswak tydens die intervensie fase, maar het later verbeter tydens die intervensie fase en het aangehou verbeter tydens die uitwas fase. Die waargenome sitgemak het groter verbetering getoon as die pyn intensiteit tydens die uitwas fase. Beide pyn intensiteit en waargenome sitgemak het verbetering getoon by die drie maande opvolg evaluasie, na voltooiing van die studie. Gevolgtrekking. Die vertikale hoogte aanpassing van die stoel en rekenaarskerm het nie die deelnemer se pyn intensiteit en waargenome sitgemak in vergelyking met die deelnemer se gewone werkstasie parameters verbeter nie. Hierdie bevindinge is nie ten voordeel van die horisontale kykhoek nie. Nietemin, ondersteun die bevindinge van hierdie studie die gebruik van die "effens onder die horisontale" kykhoek as bevorderend om die pyn intensiteit te verminder en die sitgemak van 'n kantoorwerker te verbeter.

INTRODUÇÃO: Estudos prévios já foram capazes de prover evidências científicas suficientes de que o álcool é um fator causal na ocorrência de lesões traumáticas. No entanto, informações sobre o risco de lesão de acordo com o tipo de bebida alcoólica consumida e o contexto do uso de álcool ainda são escassas na literatura. No presente estudo, uma comparação internacional sobre a associação entre o uso de álcool e a ocorrência de lesões foi realizada, com o objetivo principal de expandir o entendimento de como variáveis contextuais relacionadas ao uso de álcool e ao evento que ocasionou a lesão podem influenciar a ocorrência de lesões associadas ao consumo dessa substância. MÉTODOS: Os dados são provenientes de pacientes que foram atendidos com lesões em unidades de emergência de oito países da região da América Latina e do Caribe (ALC). Foram obtidas informações dos pacientes que relataram o uso de álcool até seis horas antes da lesão a respeito do tipo de bebida alcoólica e o volume total de álcool consumido (antes da lesão e durante uma ocasião típica no último ano), além do local do evento que ocasionou a lesão. Os pacientes que relataram não ter bebido antes da lesão também foram questionados quanto ao consumo típico de álcool no último ano e sobre o local do evento que resultou na lesão. As diferenças intra- e entre-grupos foram analisadas segundo o consumo de álcool relatado antes da lesão e durante uma ocasião típica de consumo. RESULTADOS: A cerveja foi o tipo de bebida alcoólica mais comumente relatada pelos pacientes com lesões relacionadas ao uso de álcool entre os países avaliados. Entretanto, os pacientes que fizeram uso de álcool antes da lesão apresentaram um maior consumo típico de bebidas destiladas do que aqueles que não beberam antes do evento que ocasionou a lesão. O volume total de álcool tipicamente consumido e o uso de álcool em locais públicos também apresentaram uma associação positiva com a ocorrência de lesões relacionadas ao uso de álcool. CONCLUSÕES: Os países da ALC estudados apresentaram uma associação similar entre o tipo de bebida alcoólica consumida e a ocorrência de lesões, a qual pode ser atribuída principalmente ao consumo de cerveja nessa região. Além disso, o uso de bebidas destiladas parece estar associado a um maior envolvimento com a ocorrência de lesões comparado à preferência por outros tipos de bebidas alcoólicas, assim como o consumo típico de álcool em grandes quantidades e o uso de álcool em ambientes públicos. Estratégias futuras de prevenção da violência e acidentes relacionados ao uso de álcool na ALC deveriam refletir sobre a educação do público em geral sobre a influência que o contexto do uso de álcool pode ter sobre as consequências negativas advindas do consumo dessa substância / INTRODUCTION: Previous studies have already substantiated alcohol\'s causal role in injuries. Yet the role that alcoholic beverage preferences and drinking situations play in the risk for injury is still under-investigated. In this study a crossnational comparison of the association between alcohol and injury focusing on beverage type preference and the drinking context is reported. METHODS: Data are derived from emergency room injured patients who were interviewed in eight countries in the Latin American and Caribbean (LAC) region. Patients who reported any alcohol consumption within six hours prior to being injured were inquired regarding the type of alcoholic beverage and the total alcohol volume consumed (before injury and on a typical drinking occasion during the last year), as well as the place where the injury occurred. Patients who did not drink prior to injury were also asked about their alcohol consumption on a typical drinking occasion and the injury setting. Differences within- and between-groups were evaluated regarding the drinking-in-the-event behavior and patients\' typical drinking. RESULTS: Beer was the most prevalent beverage type usually consumed among injured patients across countries, however, patients who drank before injury had a higher typical consumption of spirits than those not drinking prior to injury. The total alcohol volume typically consumed and drinking in public settings were also found to be positively associated with alcohol-related injury. CONCLUSIONS: A similar beverage-specific association with alcohol-related injury was found across LAC countries, mainly attributed to beer consumption. In addition, spirits drinkers and those who typically consume alcohol in greater quantities or were drinking in public settings before being injured seem to have a greater chance of becoming involved in injury events. Future prevention strategies applied in LAC countries should inform the public about harms from drinking associated with the context in which drinking takes place

INTRODUÇÃO: Estudos prévios já foram capazes de prover evidências científicas suficientes de que o álcool é um fator causal na ocorrência de lesões traumáticas. No entanto, informações sobre o risco de lesão de acordo com o tipo de bebida alcoólica consumida e o contexto do uso de álcool ainda são escassas na literatura. No presente estudo, uma comparação internacional sobre a associação entre o uso de álcool e a ocorrência de lesões foi realizada, com o objetivo principal de expandir o entendimento de como variáveis contextuais relacionadas ao uso de álcool e ao evento que ocasionou a lesão podem influenciar a ocorrência de lesões associadas ao consumo dessa substância. MÉTODOS: Os dados são provenientes de pacientes que foram atendidos com lesões em unidades de emergência de oito países da região da América Latina e do Caribe (ALC). Foram obtidas informações dos pacientes que relataram o uso de álcool até seis horas antes da lesão a respeito do tipo de bebida alcoólica e o volume total de álcool consumido (antes da lesão e durante uma ocasião típica no último ano), além do local do evento que ocasionou a lesão. Os pacientes que relataram não ter bebido antes da lesão também foram questionados quanto ao consumo típico de álcool no último ano e sobre o local do evento que resultou na lesão. As diferenças intra- e entre-grupos foram analisadas segundo o consumo de álcool relatado antes da lesão e durante uma ocasião típica de consumo. RESULTADOS: A cerveja foi o tipo de bebida alcoólica mais comumente relatada pelos pacientes com lesões relacionadas ao uso de álcool entre os países avaliados. Entretanto, os pacientes que fizeram uso de álcool antes da lesão apresentaram um maior consumo típico de bebidas destiladas do que aqueles que não beberam antes do evento que ocasionou a lesão. O volume total de álcool tipicamente consumido e o uso de álcool em locais públicos também apresentaram uma associação positiva com a ocorrência de lesões relacionadas ao uso de álcool. CONCLUSÕES: Os países da ALC estudados apresentaram uma associação similar entre o tipo de bebida alcoólica consumida e a ocorrência de lesões, a qual pode ser atribuída principalmente ao consumo de cerveja nessa região. Além disso, o uso de bebidas destiladas parece estar associado a um maior envolvimento com a ocorrência de lesões comparado à preferência por outros tipos de bebidas alcoólicas, assim como o consumo típico de álcool em grandes quantidades e o uso de álcool em ambientes públicos. Estratégias futuras de prevenção da violência e acidentes relacionados ao uso de álcool na ALC deveriam refletir sobre a educação do público em geral sobre a influência que o contexto do uso de álcool pode ter sobre as consequências negativas advindas do consumo dessa substância / INTRODUCTION: Previous studies have already substantiated alcohol\'s causal role in injuries. Yet the role that alcoholic beverage preferences and drinking situations play in the risk for injury is still under-investigated. In this study a crossnational comparison of the association between alcohol and injury focusing on beverage type preference and the drinking context is reported. METHODS: Data are derived from emergency room injured patients who were interviewed in eight countries in the Latin American and Caribbean (LAC) region. Patients who reported any alcohol consumption within six hours prior to being injured were inquired regarding the type of alcoholic beverage and the total alcohol volume consumed (before injury and on a typical drinking occasion during the last year), as well as the place where the injury occurred. Patients who did not drink prior to injury were also asked about their alcohol consumption on a typical drinking occasion and the injury setting. Differences within- and between-groups were evaluated regarding the drinking-in-the-event behavior and patients\' typical drinking. RESULTS: Beer was the most prevalent beverage type usually consumed among injured patients across countries, however, patients who drank before injury had a higher typical consumption of spirits than those not drinking prior to injury. The total alcohol volume typically consumed and drinking in public settings were also found to be positively associated with alcohol-related injury. CONCLUSIONS: A similar beverage-specific association with alcohol-related injury was found across LAC countries, mainly attributed to beer consumption. In addition, spirits drinkers and those who typically consume alcohol in greater quantities or were drinking in public settings before being injured seem to have a greater chance of becoming involved in injury events. Future prevention strategies applied in LAC countries should inform the public about harms from drinking associated with the context in which drinking takes place

The focus of this investigation was an analysis of the work demands being placed on South African automotive industry workers as there is a recognised problem with regard to the prevalence of musculoskeletal disorders (MSDs). Preliminary work was conducted to highlight the dominant risks and areas which elicited higher numbers of MSDs within the chosen automotive plant. An area of concern was highlighted through medical record analysis and the use of risk assessment tools, thereby prioritising the need for ergonomic intervention. In particular, the effects of varying restricted and overhead work heights on the biomechanical, physiological and psychophysical responses of an individual were investigated. Twenty-eight subjects were required to complete sixteen conditions. The conditions consisted of the adoption of restricted and upright overhead static postures, with half requiring the holding of four kilograms of weight in the hands and the remaining eight conditions having no weight. Testing was carried out using an electromyography unit, ergospirometer and a perceptual Body Discomfort Map and Scale. This involved a habituation and testing session. The results of the testing revealed the biomechanical and physiological responses were dependant on the change in height. Body discomfort was also shown to be variable over the changing height conditions. This indicates that there is a significant effect of height on an individual’s responses during overhead work. The extreme restricted (-200mm and -100mm) and upright (+300mm and +400mm) overhead conditions within this study were limiting, as they elicited the highest muscle activation, physiological responses and body discomfort ratings. Positions that are preferable to adopt, which were identified from the results in this study, indicate conditions closer to head height (0mm and +100mm) were favourable. The results therefore illustrate how awkward working postures during work are likely to elicit higher demands from an individual, which could lead to an increased risk for the development of a musculoskeletal disorder. The added factor of weight elicited significant results over all variables, excluding a respiratory The focus of this investigation was an analysis of the work demands being placed on South African automotive industry workers as there is a recognised problem with regard to the prevalence of musculoskeletal disorders (MSDs). Preliminary work was conducted to highlight the dominant risks and areas which elicited higher numbers of MSDs within the chosen automotive plant. An area of concern was highlighted through medical record analysis and the use of risk assessment tools, thereby prioritising the need for ergonomic intervention. In particular, the effects of varying restricted and overhead work heights on the biomechanical, physiological and psychophysical responses of an individual were investigated. Twenty-eight subjects were required to complete sixteen conditions. The conditions consisted of the adoption of restricted and upright overhead static postures, with half requiring the holding of four kilograms of weight in the hands and the remaining eight conditions having no weight. Testing was carried out using an electromyography unit, ergospirometer and a perceptual Body Discomfort Map and Scale. This involved a habituation and testing session. The results of the testing revealed the biomechanical and physiological responses were dependant on the change in height. Body discomfort was also shown to be variable over the changing height conditions. This indicates that there is a significant effect of height on an individual’s responses during overhead work. The extreme restricted (-200mm and -100mm) and upright (+300mm and +400mm) overhead conditions within this study were limiting, as they elicited the highest muscle activation, physiological responses and body discomfort ratings. Positions that are preferable to adopt, which were identified from the results in this study, indicate conditions closer to head height (0mm and +100mm) were favourable. The results therefore illustrate how awkward working postures during work are likely to elicit higher demands from an individual, which could lead to an increased risk for the development of a musculoskeletal disorder. The added factor of weight elicited significant results over all variables, excluding a respiratory individual.