BackgroundThe study was conducted to determine the clinical and cost effectiveness of enhanced multi-disciplinary teams (EMDTs) vs. ‘usual care’ for the treatment of pressure ulcers in long term care (LTC) facilities in Ontario, CanadaMethodsWe conducted a multi-method study: a pragmatic cluster randomized stepped-wedge trial, ethnographic observation and in-depth interviews, and an economic evaluation. Long term care facilities (clusters) were randomly allocated to start dates of the intervention. An advance practice nurse (APN) with expertise in skin and wound care visited intervention facilities to educate staff on pressure ulcer prevention and treatment, supported by an off-site hospital based expert multi-disciplinary wound care team via email, telephone, or video link as needed. The primary outcome was rate of reduction in pressure ulcer surface area (cm2/day) measured on before and after standard photographs by an assessor blinded to facility allocation. Secondary outcomes were time to healing, probability of healing, pressure ulcer incidence, pressure ulcer prevalence, wound pain, hospitalization, emergency department visits, utility, and cost.Results12 of 15 eligible LTC facilities were randomly selected to participate and randomized to start date of the intervention following the stepped wedge design. 137 residents with a total of 259 pressure ulcers (stage 2 or greater) were recruited over the 17 month study period. No statistically significant differences were found between control and intervention periods on any of the primary or secondary outcomes. The economic evaluation demonstrated a mean reduction in direct care costs of $650 per resident compared to ‘usual care’. The qualitative study suggested that onsite support by APN wound specialists was welcomed, and is responsible for reduced costs through discontinuation of expensive non evidence based treatments. Insufficient allocation of nursing home staff time to wound care may explain the lack of impact on healing.ConclusionEnhanced multi-disciplinary wound care teams were cost effective, with most benefit through cost reduction initiated by APNs, but did not improve the treatment of pressure ulcers in nursing homes. Policy makers should consider the potential yield of strengthening evidence based primary care within LTC facilities, through outreach by APNs.Trial registrationClinicalTrials.gov identifier NCT01232764

The purpose of this paper is to consider how gender, class and power have been addressed in the work stress literature and to propose an alternative approach that highlights the role of power in the development of work-related stress. We begin with a discussion and critique of prominent work-related stress models. The models' conceptualizations of work-related stress and their relationships to issues of class and gender are used as focal points for discussion. We show that explanations for gender or class differences in stress vary markedly by disciplinary perspective. Some models emphasize individual coping mechanisms, while other models focus on individual-level exposures or the work environment, in the production of work-related stress. Notions of power or control are often invoked in these models, but they tend to be narrowly conceptualized. Often the research presents a series of empirical ®ndings rather than an integrated conceptual model which clearly speci®es the pathways by which individual work experiences are linked to health and to the broader social context. Drawing on empirical ®ndings and theoretical insights from a broad range of disciplinary perspectives, we build a conceptual framework relating power to work-related stress. This model can provide us with a deeper understanding of the determinants of stress, the relationships between stress and the broader social context, and the relationships between stress and social factors such as class and gender. Speci®cally, we suggest that power can in¯uence work-related stress through the distribution of stressors in the workplace and via meaning. Copyright # 2001 John Wiley & Sons, Ltd.Key words: stress; work; health; power; model; theory; Bourdieu; meaning; gender; class INTRODUCTIONThe psycho-social environment at work and its implications for health are important current topics of concern in the occupational health arena. In particular, the deleterious effects of work-related stress have emerged as a signi®cant issue among workers. A recent survey indicates that 26% of workers reported stress, mental or emotional health problems arising from work in the last year, compared to 9% that reported workplace injury and another 9% who said they suffered from work-related physical illness (Berger, 1996 The roles of gender and class in the production of work-related stress are central issues and are worthy of our consideration for both empirical and theoretical reasons. Empirically signi®cant relationships between class and coronary heart disease (CHD) have been found Ð workers are more likely to develop CHD, the lower their social class (Marmot et al., 1997). Women tend to have higher rates of self-reported stress, distress and depression compared to men (Aneshensel and Pearlin, 1987). Although considerable attention has been directed at empirically demonstrating associations between these factors and health outcomes, there has been less effort directed towards theorizing the socio-psychological pathways which may provide an explanation for these ®nd...

No abstract

This is the second of two papers that systematically review available scientific evidence on the causes of disability from occupational low back pain, and the effectiveness of interventions to prevent it after its onset (secondary prevention). This paper reviews the national history of how back pain and the risk factors for its extension into chronic disability, followed by a critical summary of intervention studies attempting to reduce the duration of this disability, and to evaluate the results.

This is the first of two papers that systematically review available scientific evidence on the causes of disability from occupational low back pain, and the effectiveness of interventions to prevent it-before disability begins (primary prevention-Part I) and after its onset (secondary prevention-Part II). This first paper reviews the risk factors for the onset of pain and associated disability followed by a critical summary of intervention studies attempting to achieve prevention and to evaluate the results.