International Journal of Current Research and Review
ISSN: 2231-2196 (Print)ISSN: 0975-5241 (Online)
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IJCRR - 7(24), December, 2015

Pages: 51-55

Date of Publication: 20-Dec-2015


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LOWER LIMB VARICOSE VEINS AMONG NURSES: A CROSS SECTIONAL STUDY IN UDAIPUR

Author: Neeta Mishra, Shiv Lal Solanki, Surya Mishra

Category: Healthcare

Abstract:Background: Varicose vein is a saccular, tortuous, dilated vein of lower limb invariably associated with local valvular incompetency. They not only can cause cosmetic problems but also can cause clinical symptoms such as pain and heaviness in the lower limb. It is most often associated with occupations requiring prolong orthostasis like teachers nursing staff, shopkeepers etc. In spite of this strong relationship with occupations requiring prolonged orthostasis, epidemiological studies on working population are limited. We conducted this study to identify the occupational and demographic risk factors of lower limb varicose vein which could be interventional in improving working atmosphere and quality of life for their long term nursing career. Method: It was a cross sectional study conducted from February 2015 to March 2015 Data was collected through a self-filled preformed questionnaire from 364 nurses working at GMCH and Associated Hospitalsin Udaipur, Rajasthan. The nurses having lower limb VV were subject to clinical examination by the experts for confirmation of the diagnosis.
Results:
A total of 364 nurses participated in the survey and 88 (24.17%) had lower limb VV. The female nurses had slightly higher prevalencecompared with their male counterpart (24.50% V/S 22.58%). The occupational risk factors responsible for lower limb VV among nurses were longer work history (40.42% P- 0.001) longer working hours (>8 hrs 38.70%, p- < 0.001) and prolonged orthostasis (standing longer \? 57.14%) beside patients bed. They are older in age (28.30%, p- 0.001) and also having a family history of VV (38.70%, p- 0.006) Conclusion: In nurses older age, family history, longer work history, longer working hours and prolonged standing beside patient bed are major risk factors for developing lower limb varicose vein.

Keywords: Risk factor, Tortuous, Orthostasis, Occupation

Full Text:

INTRODUCTION

A varicose vein is a palpable subcutaneous vein that is dilated tortuous, saccular, and generally larger than 3mm and mainly seen in lower limbs. It is invariably associated with local valvular incompetency and more common in women than men. Varicose vein are known to be more common among profession such as police men, teachers, nurses, shopkeeper& bus conductors who has to stand for longer time during their duties. Even though the exact cause of varicose vein is unknown there are some contributory factors responsible for varicose vein. Some of the major risk factors are age, gender, pregnancy, family history and prolonged standing Among these risk factors nurses have the two important risk factorsgender & prolonged standing during duty hours. They are at higher risk of developing varicose vein because of their nature of job which require prolonged standing at patient bedside& this increase their risk of getting varicose vein later in their life. With regards to the gender majority of the nurses are female nationwide & internationally. In UK male to female ratio among nurse is 1 : 10 in Canada it is 1 : 19 while in India it is around 1 : 5. The only way to avoid the varicose vein among nurses is to follow the preventive measures. Varicose vein is the most common chronic condition in north America and western Europe, less common in the Mediterranean, south America and India and even less so in the far East & Africa. According to international statistics 25 percent of women & 18 percent of men in general population are affected by varicose vein. Framingham study reported that 27 percent of the Americans had some form of varicose disease in their legs. It is estimated that 20 to 25 million Americans have varicose vein. In India 10 to 20 percent of the general population eventually develop varicose vein in due course of their life.

METHOD AND COLLECTION OF DATA

Information was collected from nurses working in GMCH and Associated Hospitals in Udaipur, through a self-filled questionnaire &the physical examination was performed by the investigator for the varicose vein (C2) based on the clinical finding using CEAP standards. (Clinical, Etiological, Anatomical & Pathophysiological classification for varicose vein)

Study Period:
February 2015 to March 2015.

Definitions:
Varicose Vein-Dilatedpalpablesubcutaneous veins of leg, generally more than 3mm in diameter (C2)

Reticular Vein- Dilated non-palpable subcutaneous veins less than 3mm in diameter. Telangiectasia- Dilated intradermal veins less than 1mm in diameter. Chronic venous insufficiency- Varicosevein with its complication (C3-C6) or symptomatic varicose vein.

Procedure & Assessment:
The collected data were entered in to the MS office including MS word, MS excel and MS access for assessment of prevalence and relationship of risk factors of varicose veins among nursing staff and further data were processed and analyzed for percentages, proportions. Appropriate statistical tests were applied to draw the inferences andsignificance and observations were presented as tables, graphs and figuresaccordingly

Ethical Clearance
Ethical clearance was obtained from Human Resource Ethical Committee of the Geetanjali Medical College and Hospital, Geetanjali University, Udaipur.

Results

A total of 364 nurses participated in the study, including 302 female nurses and 62 male nurses. The average age was 46.22 years and the male to female ratio was 1:4.8. There were88 cases of lower limb VV showing the prevalence of 24.17%. The prevalence among female nurses was slightly higher than male (24.50% V/s 22.58%) VV of lower limb were more common in older age group i.e. in the age group of 36-50 years (28.88%) and in the age group of 51-66 years (28.30%). In comparison with nurses without lower limb VV,those who had lower limb VV were more experienced having 6 or more years of experience (40.42% p<0.001), had more than 8 hours duty per day (38.70% p <0.001) and more hours of standing in working (57.14%, p <0.001). Constipation, habits of smoking and drinking of alcohol did not appear to be significant risk factor of lower limb VV, so are the OCP use and hormone replacement therapy(HRT) in female nurses. Among the other risk factors positive family history (38.70%, p 0.006) & number of child birth ( 3 or more child birth 38.37%, p 0.002) appeared to be a significant predictor.

DISCUSSION

Varicose vein of the lower limbs is a penalty which a human being has to pay for his erect posture. The reported prevalence rate of VV differed from one series to another ranging from 2 % to 56% in men and 1% to 73% in women probably affected by various factors like age, sex, gender etc. A study conducted by1 on 541 Japanese women the prevalence rate was 45% while in other study2 conducted in Shanghai area of China on 30712 workers the prevalence rate was 8.39% of lower limb VV. In our study the prevalence rate of lower limb in nurses was 24.17% which was within the reported range. In our study the incidence of VV was nearly similar in women and men (24.50% and 22.58%) and increased consistently with age. Similar findings were observed by3,4 and study by5,6 among nurses reported very high incidence rate (73.9% and 62.5%) not match to our results. Family history was very strong risk factor for VV. In our study (38.70%) nurses had family history of VV, our results are supported by5,7-10 but study of11 not support our results. However the study by8 revealed that the risk of developing VV was 90% when both parents presented the disease and 25% for males and 62% for females when only one of the parents was affected. The published data on the effect of smoking and drinking alcohol are limited.A large case control study conducted by10 on 1806 patients of lower limb venous insufficiency found that smoking more than 10 cigarettes per day was associated with a higher prevalence of VV but smoking less was not. A study by17 found that alcohol intake and smoking were not risk factors for venous insufficiency. In our study alcohol orsmoking was not found to have a significant association with VV. There is significant relationship between VV and hours of positional factors such as sitting and standing. Similar results were observed by7,10,16but contrasts with17,18. The effect of prolonged standing beside the patient bed and long working hours (> 8 hours/ day) are the primary focus of this study, we found that both the occupational risk factors prolonged standing (57.14%, p <0.001) and long working hours (38.70%, p <0.001), were significantly associated with the lower limb VV. A study18 on 387 male European workers also foundthat prolonged standing was an aggravating factor of lower limb VV. A study on female cotton workers19also found a greater prevalence of lower limb VV in those who worked standing up. A prospective study in Denmark conducted by20found that jobs requiring prolonged standing were associated with a relative risk of 1.75 for hospitalization due to VV. A cross sectional study conducted by12 in Germany on 9935 civil servants also reported similar results. Our results are also supported by6,14,15. Hormonal factors in women, number of births were related to VV. In our study, a trend was detected between pregnancy and increased incidence of VV, our results are supported by5,10,12. In study done by9 found that the changes occur with only one pregnancy. According to13 pregnancy was no longer a risk factor. There is no evidence that OCP cause VV but our study shows slight increase. A study by21foundthat there is a slight increased risk of VV due to hormone replacement therapy (HRT).This is in contrast to our results. In summary there are sufficient evidences to support that prolonged standing beside the patient’s bed and long duty hours are associated with the occurrence of lower limb VV in nurses.

CONCLUSION

Family history of varicose vein, prolonged standing, and long working hours are the major risk factors for developing lower limb varicose vein. There for preventive measures such as compression stockings and taking small breaks at work during long duty hours and prolong standing to rest leg can help in prevention of lower leg varicose vein among nurses.

ACKNOWLEDGEMENT

Authors acknowledge the immense help received from the scholars, whose articles are cited and included in references of this manuscript. The authors of this manuscript are also grateful to editors, publishers, and authors of all those articles, journals and books from where the literature for this article has been reviewed and discussed.

References:

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 2. Sun JM: Epidemiologic study on peripheral vascular diseases in Shanghai.ZhonghuaWaiKeZaZhi 1990, 28:480-483. 510–481

3. Ziegler S, Eckhardt G, Stoger R, Machula J, Rudiger HW. High prevalence of chronic venous disease in hospital employees. Wiener KlinischeWochenschrift 2003;115:575-579.

4. Tomei F, BaccoloTp, Tomao E, Palmi S, RosatiMv. Chronic venous disorders and occupations. American J of industrial medicine 1999;36: 653-665.

5. BN Sharif Nia H, Chan YH, Haghdoost AA, SoleimaniMA.Varicose veins of the legs among nurses: Occupational and demographic characterstics. Int. J of nursing practice Academia.edu 2014; 1-8

6. Nasiri-Foourg A, Kazemi T, Nakhaii N, Kazemi N. lower limb varicose veins and their relationship with risk factor in nurses of the Birjand University of Medical sciences hospital. J of Birjand University of Medical Sciences 2005; 12: 9-15.

7. MH Criqui, JO Denenberg, J Bergan, RD Langer, AFronek. Risk factor for chronic venous diseases : The San Diego Population Study. J of vascular surgery 2007; 46: 331-7.

8. Cornu-Thenard A, Boivin P, Baud JM, De Vincenzi I, Carpentier PH: Importance of the familial factor in varicose disease. Clinical study of 134 families.JDermatolSurgOncol 1994, 20:318- 326.

9. Stvrtinova V, Kolesar J, Wimmer G: Prevalence of varicose veins of the lower limbs in the women working at a department store.IntAngiol 1991, 10:2-5.

10. Gourgou S, Dedieu F, Sancho-Garnier H: Lower limb venous insufficiency and tobacco smoking: a case–control study.Am J Epidemiol 2002, 155:1007-1015.

11. Coughlin LB, Gandy R, Rosser S, de Cossart L. factors associated with varicose veins in pregnant women.Phlebology 2001; 16: 41-50.

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13. Guberan E, Widmer LK, Rougemont A, Glaus L. Epidemiology of spider webs. Vasa 1974;3:391-5.

14. Carpentier PH, Maricq HR, Biro C, Poncot-Makinen CO, Franco A: Prevalence, risk factors, and clinical patterns of chronic venous disorders of lower limbs: a population-based study in France. J VascSurg 2004, 40:650-659.

15. Fowkes FG, Lee AJ, Evans CJ, Allan PL, Bradbury AW, Ruckley CV: Lifestyle risk factors for lower limb venous reflux in the general population: Edinburgh Vein Study. Int J Epidemiol 2001, 30:846-852.

16. Weddell JM. Varicose veins pilot study, 1966. Br J PrevSoc Med 1969;23:179-86.

17. Ahumada M, Vioque J: Prevalence and risk factors of varicose veins in adults.MedClin 2004, 123:647-651.

18. Krijnen RM, De Boer EM, Ader HJ, Bruynzeel DP. Venous insufficiency in male workers with a standing profession. Part 1:epidemiology.Dermatology 1997, 194:111-120.

19. Mekky S, Schilling RS, Walford J: Varicose veins in women cotton workers. An epidemiological study in England and Egypt.Br Med J 1969, 2:591-595.

20. Tuchsen F, Krause N, Hannerz H, Burr H, Kristensen TS: Standing at work and varicose veins.Scand J Work EnviroHealth 2000, 26:414-420.

21. Stachowiak G, Polac I, Stefanczyk L, Owczarek D, Jedrzejczyk S, Pertynski T. The impact of hormone replacement therapy applied in women with varicose veins on changes in coagulation and fibrinolysis. 2003;15(90):521-4.

Announcements

Dr. Pramod Kumar Manjhi joined Editor-in-Chief since July 2021 onwards

COPE guidelines for Reviewers

SCOPUS indexing: 2014, 2019 to 2021


Awards, Research and Publication incentive Schemes by IJCRR

Best Article Award: 

One article from every issue is selected for the ‘Best Article Award’. Authors of selected ‘Best Article’ are rewarded with a certificate. IJCRR Editorial Board members select one ‘Best Article’ from the published issue based on originality, novelty, social usefulness of the work. The corresponding author of selected ‘Best Article Award’ is communicated and information of award is displayed on IJCRR’s website. Drop a mail to editor@ijcrr.com for more details.

Women Researcher Award:

This award is instituted to encourage women researchers to publish her work in IJCRR. Women researcher, who intends to publish her research work in IJCRR as the first author is eligible to apply for this award. Editorial Board members decide on the selection of women researchers based on the originality, novelty, and social contribution of the research work. The corresponding author of the selected manuscript is communicated and information is displayed on IJCRR’s website. Under this award selected women, the author is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.

Emerging Researcher Award:

‘Emerging Researcher Award’ is instituted to encourage student researchers to publish their work in IJCRR. Student researchers, who intend to publish their research or review work in IJCRR as the first author are eligible to apply for this award. Editorial Board members decide on the selection of student researchers for the said award based on originality, novelty, and social applicability of the research work. Under this award selected student researcher is eligible for publication incentives. Drop a mail to editor@ijcrr.com for more details.


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A Study by Varsha M. Shindhe et al. entitled "A Study on Effect of Smokeless Tobacco on Pulmonary Function Tests in Class IV Workers of USM-KLE (Universiti Sains Malaysia-Karnataka Lingayat Education Society) International Medical Programme, Belagavi" is awarded Best article of Vol 12 issue 14, July 2020
A study by Amruta Choudhary et al. entitled "Family Planning Knowledge, Attitude and Practice Among Women of Reproductive Age from Rural Area of Central India" is awarded Best Article for special issue "Modern Therapeutics Applications"
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A study by Asha Menon "Women in Child Care and Early Education: Truly Nontraditional Work" is awarded Best Article for Vol 10 issue 13
A study by Deep J. M. "Prevalence of Molar-Incisor Hypomineralization in 7-13 Years Old Children of Biratnagar, Nepal: A Cross Sectional Study" is awarded Best Article for Vol 10 issue 11 of IJCRR
A review by Chitra et al to analyse relation between Obesity and Type 2 diabetes is awarded 'Best Article' for Vol 10 issue 10 by IJCRR. 
A study by Karanpreet et al "Pregnancy Induced Hypertension: A Study on Its Multisystem Involvement" is given Best Paper Award for Vol 10 issue 09

List of Awardees

A Study by Ese Anibor et al. "Evaluation of Temporomandibular Joint Disorders Among Delta State University Students in Abraka, Nigeria" from Vol 13 issue 16 received Emerging Researcher Award


A Study by Alkhansa Mahmoud et al. entitled "mRNA Expression of Somatostatin Receptors (1-5) in MCF7 and MDA-MB231 Breast Cancer Cells" from Vol 13 issue 06 received Emerging Researcher Award


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Disclaimer: International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal.



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International Journal of Current Research and Review (IJCRR) provides platform for researchers to publish and discuss their original research and review work. IJCRR can not be held responsible for views, opinions and written statements of researchers published in this journal

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